Provider Demographics
NPI:1982872461
Name:BLAMIRES, ERIC S A (DMD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:S A
Last Name:BLAMIRES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BECKWITH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5931
Mailing Address - Country:US
Mailing Address - Phone:719-660-2791
Mailing Address - Fax:719-392-1589
Practice Address - Street 1:135 BECKWITH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-5931
Practice Address - Country:US
Practice Address - Phone:719-660-2791
Practice Address - Fax:719-392-1589
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5935496-9922122300000X
CO104181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist