Basic Information
| Provider Information | |||||||||
| NPI: | 1487847703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLASER | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5016 W HOBBY HORSE DR | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850835452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232660243 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3618 W ANTHEM WAY | ||||||||
| Address2: | SUITE #D-104 | ||||||||
| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850860419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359873 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 5610 | AZ | Y | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | D-3495 | ID | N | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.