Provider Demographics
NPI:1689370496
Name:BYRON M BLASCO D M D LTD
Entity Type:Organization
Organization Name:BYRON M BLASCO D M D LTD
Other - Org Name:BLASCO DENTAL & AESTHETICS OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-933-1300
Mailing Address - Street 1:9940 W FLAMINGO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8553
Mailing Address - Country:US
Mailing Address - Phone:702-933-1300
Mailing Address - Fax:
Practice Address - Street 1:9940 W FLAMINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8553
Practice Address - Country:US
Practice Address - Phone:702-933-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992881171OtherNPPES
NV2283OtherSTATE DENTAL LICENSE