Provider Demographics
NPI:1639292378
Name:BLASS, ANGELINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:
Last Name:BLASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 N ANKENY BLVD
Mailing Address - Street 2:SUITE 26
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4705
Mailing Address - Country:US
Mailing Address - Phone:515-965-5999
Mailing Address - Fax:
Practice Address - Street 1:2785 N ANKENY BLVD
Practice Address - Street 2:SUITE 26
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4705
Practice Address - Country:US
Practice Address - Phone:515-965-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010948A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist