Provider Demographics
NPI:1629192190
Name:BLAZER, MARCIA L (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:L
Last Name:BLAZER
Suffix:
Gender:F
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD
Mailing Address - Street 2:140
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-596-8273
Mailing Address - Fax:480-596-5777
Practice Address - Street 1:11000 N SCOTTSDALE RD
Practice Address - Street 2:140
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-596-8273
Practice Address - Fax:480-596-5777
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist