Bryan R Blazer DDS PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019.028688 Issued in IL

Legal business name

BRYAN R BLAZER DDS PC

Practice address

431 Summit St Ste 105
Elgin, IL 60120-3861

Phone

(847) 742-6717

NPI assigned

Jan 13, 2017

Last updated

Jan 13, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryan R Blazer, DDS

Title

President/Owner

Phone

(847) 742-6717

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1578009577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 SUMMIT ST STE 105",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601203861",
            "telephone_number": "847-742-6717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 SUMMIT ST STE 105",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601203861",
            "telephone_number": "847-742-6717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN R BLAZER DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "BLAZER",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "847-742-6717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.028688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jim Brunetti
• Chloe Rose Brunner
• Jack Michael Brunson, PA-C
• Josh Brunsting
• Sara Brunsting, LPC
• Daniel J. Brzostowski, M.S., L.C.P.C.
• Arron Dennis Buck, DPT
• Aaliyah Buford
• Jake Buhmann
• Brian James Builta, MA, CADC

• Dental Clinic/Center in Elgin, IL
• Providers in Elgin, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.