Provider Demographics
NPI:1689795940
Name:BLASSIC, KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:BLASSIC
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 1:5225-D HICKORY PARK DR.
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-270-5225
Mailing Address - Fax:804-270-3266
Practice Address - Street 1:5225 HICKORY PARK DR.
Practice Address - Street 2:SUITE D
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:804-270-5225
Practice Address - Fax:804-270-3266
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice