Provider Demographics
NPI:1851500292
Name:ALLEN J. BLASS, D.D.S.
Entity Type:Organization
Organization Name:ALLEN J. BLASS, D.D.S.
Other - Org Name:ALLEN J. BLASS & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-236-7222
Mailing Address - Street 1:4920 ROSWELL RD NE
Mailing Address - Street 2:SUITE 13A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2601
Mailing Address - Country:US
Mailing Address - Phone:404-236-7222
Mailing Address - Fax:404-250-9143
Practice Address - Street 1:4920 ROSWELL RD NE
Practice Address - Street 2:SUITE 13A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2601
Practice Address - Country:US
Practice Address - Phone:404-236-7222
Practice Address - Fax:404-250-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006716122300000X
GA008304122300000X
GA008787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty