Provider Demographics
NPI:1932176203
Name:BLAZZARD, ALEX D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:D
Last Name:BLAZZARD
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 1:840 PINNACLE CT
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-3303
Mailing Address - Country:US
Mailing Address - Phone:702-345-8686
Mailing Address - Fax:
Practice Address - Street 1:840 PINNACLE CT
Practice Address - Street 2:SUITE 6A
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-3303
Practice Address - Country:US
Practice Address - Phone:702-345-8686
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV44951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice