Daniel Milton Blaho Jr., DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Laurenceville, GA
NPI 1962500538 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962500538
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 10001 (GA)
- Practice address
- 171 Gwinnett Dr
Suite B
Laurenceville, GA 30045 - Phone
- (770) 995-7960
- Fax
- (770) 995-7367
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 10001 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gwinnett Oral & Maxillofacial Surgery, PC | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 10001 | GA | Yes |
Addresses
Primary practice location
171 Gwinnett Dr
Suite B
Laurenceville, GA 30045
Mailing address
171 Gwinnett Dr
Suite B
Laurenceville, GA 30045
Phone (770) 995-7960
Other providers in Laurenceville, GA
All providers in Laurenceville, GA · Oral and Maxillofacial Surgery (Dentist) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.