Joseph A. Blaes, DDS
Individual provider Active NPI Dentist · Fenton, MO
NPI 1679740567 · NPPES record last updated May 11, 2008
Key facts
- NPI
- 1679740567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 010040 (MO)
- Practice address
- 1736 Gilsinn LN
Fenton, MO 63026-2004 - Phone
- (636) 343-6808
- Fax
- (636) 343-6810
- NPI assigned
- May 11, 2008
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 010040 | MO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 010040 | MO | Yes |
Addresses
Primary practice location
1736 Gilsinn LN
Fenton, MO 63026-2004
Mailing address
1736 Gilsinn LN
Fenton, MO 63026-2004
Phone (636) 343-6808
Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.