Provider Demographics
NPI:1700063005
Name:GEORGE F. BLAICH, DMD & ASSOCIATES, PC
Entity Type:Organization
Organization Name:GEORGE F. BLAICH, DMD & ASSOCIATES, PC
Other - Org Name:DENTAL ARTS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BLAICH
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:573-785-0111
Mailing Address - Street 1:1300 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3314
Mailing Address - Country:US
Mailing Address - Phone:573-785-0111
Mailing Address - Fax:573-785-3840
Practice Address - Street 1:1300 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3314
Practice Address - Country:US
Practice Address - Phone:573-785-0111
Practice Address - Fax:573-785-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO135471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty