Justin Edward Blazejewski, DMD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1860 E Charleston Blvd
Las Vegas, NV 89104-1949

Phone

(702) 779-3668

NPI assigned

May 26, 2021

Last updated

May 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 13, 2026 through Jul 13, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Mexico Dentistry Prada, PLLC

  • Dentist
  • Albuquerque, NM
  • NPI 1376215731
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1154996700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 S RANCHO DR STE 205",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891024456",
            "telephone_number": "702-779-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 E CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041949",
            "telephone_number": "702-779-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZEJEWSKI",
        "first_name": "JUSTIN",
        "middle_name": "EDWARD",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Blasco
• Lesie Blascoe, M.ED, MBA
• Haley Amanda Blattel
• Kyla Blaydes
• Crystina Louise Blaze
• Alexa Blazek
• Beau Irvine Blazek, DO
• Stephanie Blazek, CHW
• Bianca Rose Blazer
• Blazing Fast Deliveries

• Student in an Organized Health Care Education/Training Program in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Student in an Organized Health Care Education/Training Program in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.