Individual
DR. GARY BLAICH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.A.
Contact information
Practice address
1509 W 4TH ST, COFFEYVILLE, KS 67337-3307
(620) 251-0604
Mailing address
1509 W 4TH ST, COFFEYVILLE, KS 67337-3307
(620) 251-0604
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6743
KS
Other
Enumeration date
02/16/2006
Last updated
07/08/2007
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