Provider Demographics
NPI:1740616275
Name:BLASI BERIAIN, IGNACIO JR (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:
Last Name:BLASI BERIAIN
Suffix:JR
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1912
Mailing Address - Country:US
Mailing Address - Phone:267-670-4271
Mailing Address - Fax:
Practice Address - Street 1:3224 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1912
Practice Address - Country:US
Practice Address - Phone:267-670-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics