Basic Information
| Provider Information | |||||||||
| NPI: | 1376682120 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENTAL OFFICE OF IRENE K BLAESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5999 DE ZAVALA RD | ||||||||
| Address2: | STE #122 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106911333 | ||||||||
| FaxNumber: | 2105612599 | ||||||||
| Practice Location | |||||||||
| Address1: | 5999 DE ZAVALA RD | ||||||||
| Address2: | STE #122 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106911333 | ||||||||
| FaxNumber: | 2105612599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLAESS | ||||||||
| AuthorizedOfficialFirstName: | IRENE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2106911333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 19006 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.