# JOHN P BLAZIC DDS INC

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

## Provider details

- **NPI number:** 1407152705
- **Authorized official:** DR. JOHN P BLAZIC DDS (OWNER)
- **Authorized official phone:** (513) 829-4111

## Contact information

- **Practice address:** 1251 NILLES ROAD, SUITE 12, FAIRFIELD, OH 45014-7205
- **Practice address phone:** (513) 829-4111
- **Practice address fax:** (513) 829-5140
- **Mailing address:** 1251 NILLES ROAD, SUITE 12, FAIRFIELD, OH 45014-7205
- **Mailing address phone:** (513) 829-4111
- **Mailing address fax:** (513) 829-5140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 30017039 | OH | Yes |

## Other

- **Enumeration date:** 02/03/2011
- **Last updated:** 02/03/2011