# JOHN G BLAZIC DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205000213
- **Authorized official:** DONNA BARCUS (OFFICE MANAGER)
- **Authorized official phone:** (317) 839-4604

## Contact information

- **Practice address:** 1655 HAWTHORNE DR, SUITE F & G, PLAINFIELD, IN 46168-1895
- **Practice address phone:** (317) 839-4604
- **Practice address fax:** (317) 837-2436
- **Mailing address:** 1655 HAWTHORNE DR, SUITE F & G, PLAINFIELD, IN 46168-1895
- **Mailing address phone:** (317) 839-4604
- **Mailing address fax:** (317) 837-2436

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/22/2008
- **Last updated:** 04/22/2008