Individual
DR. BRYAN BLAZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
77 NEALY AVE, 633D MEDICAL GROUP, JOINT BASE LANGLEY-EUSTIS, VA 23665-2040
(764) 225-5039
Mailing address
77 NEALY AVE, 633D MEDICAL GROUP, JOINT BASE LANGLEY-EUSTIS, VA 23665-2040
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028688
IL
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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