Provider Demographics
NPI:1508624222
Name:BLASINGAME DENTAL CORPORATION
Entity Type:Organization
Organization Name:BLASINGAME DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-241-3302
Mailing Address - Street 1:384 HARTNELL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1884
Mailing Address - Country:US
Mailing Address - Phone:530-241-3302
Mailing Address - Fax:530-241-3321
Practice Address - Street 1:4545 QUAIL LAKES DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5257
Practice Address - Country:US
Practice Address - Phone:530-241-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty