Provider Demographics
NPI:1801514799
Name:BLESSING AESTHETICS, PA
Entity type:Organization
Organization Name:BLESSING AESTHETICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:BLESSING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-775-1898
Mailing Address - Street 1:11211 PROSPERITY FARMS RD STE D123
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3476
Mailing Address - Country:US
Mailing Address - Phone:561-775-1898
Mailing Address - Fax:
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE D123
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3476
Practice Address - Country:US
Practice Address - Phone:561-775-1898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184768566OtherNPI
FL1316280928OtherNPI