Organization
BRYAN R BLAZER DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN R BLAZER DDS (PRESIDENT/OWNER)
(847) 742-6717
Entity
Organization
Contact information
Practice address
431 SUMMIT ST STE 105, ELGIN, IL 60120-3861
(847) 742-6717
Mailing address
431 SUMMIT ST STE 105, ELGIN, IL 60120-3861
(847) 742-6717
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019.028688
IL
Other
Enumeration date
01/13/2017
Last updated
01/13/2017
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