Organization
GARY BLAICH D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY BLAICH D.D.S. (PRESIDENT)
(620) 251-0604
Entity
Organization
Contact information
Practice address
1509 W 4TH ST, COFFEYVILLE, KS 67337-3307
(620) 251-0606
Mailing address
1509 W 4TH ST, COFFEYVILLE, KS 67337-3307
(620) 251-0606
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
6743
KS
Other
Enumeration date
04/13/2007
Last updated
08/22/2020
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