Provider Demographics
NPI:1891916508
Name:BLAZAR, JOHN LEWIS (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEWIS
Last Name:BLAZAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 RICHMOND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4160
Mailing Address - Country:US
Mailing Address - Phone:216-464-0555
Mailing Address - Fax:216-464-0928
Practice Address - Street 1:3401 RICHMOND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4160
Practice Address - Country:US
Practice Address - Phone:216-464-0555
Practice Address - Fax:216-464-0928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice