Provider Demographics
NPI:1760050793
Name:ALAGBA, BLESSING (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLESSING
Middle Name:
Last Name:ALAGBA
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 1:3141 E BROAD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6447
Mailing Address - Country:US
Mailing Address - Phone:682-400-4137
Mailing Address - Fax:
Practice Address - Street 1:3550 E BROAD ST STE 112
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5633
Practice Address - Country:US
Practice Address - Phone:336-340-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37519122300000X, 1223G0001X
MI29510008471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist