Alan Joseph Blas, DDS

Individual provider Active NPI General Practice Dentistry · Morton Grove, IL

NPI 1346370665 · NPPES record last updated Jun 20, 2013

Key facts

NPI
1346370665
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
019015651 (IL)
Practice address
8933 Oriole Ave
Alan J Blas DDS
Morton Grove, IL 60053-1853
Phone
(847) 657-7997
Fax
(847) 657-7987
NPI assigned
Mar 6, 2007
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
019015651ILMDGeneral Practice Dentistry
021000990ILMDOrthodontics and Dentofacial Orthopedic Dentist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019015651 IL Yes
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 021000990 IL

Addresses

Primary practice location

8933 Oriole Ave
Alan J Blas DDS
Morton Grove, IL 60053-1853

Mailing address

8933 Oriole Ave
Alan J Blas DDS
Morton Grove, IL 60053-1853
Phone (847) 657-7997

Other providers in Morton Grove, IL

All providers in Morton Grove, IL · General Practice Dentistry in Illinois

Sources for this page

Verify at the official NPI Registry.