Provider Demographics
NPI:1851438964
Name:BLAIK, THOMAS KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:BLAIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8775 CLOUDLEAP CT
Mailing Address - Street 2:SUITE 236
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3044
Mailing Address - Country:US
Mailing Address - Phone:410-730-2483
Mailing Address - Fax:410-730-1179
Practice Address - Street 1:8775 CLOUDLEAP CT
Practice Address - Street 2:SUITE 236
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3044
Practice Address - Country:US
Practice Address - Phone:410-730-2483
Practice Address - Fax:410-730-1179
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD90951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice