Provider Demographics
NPI:1982007803
Name:BLAINE DENTISTRY, PC
Entity Type:Organization
Organization Name:BLAINE DENTISTRY, PC
Other - Org Name:BLAINE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERPICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-757-6000
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:1384 109TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4515
Practice Address - Country:US
Practice Address - Phone:763-757-6000
Practice Address - Fax:763-757-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty