Provider Demographics
NPI:1679138036
Name:DENTAL ARTS GROUP L.L.C
Entity type:Organization
Organization Name:DENTAL ARTS GROUP L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLAICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-785-0111
Mailing Address - Street 1:2700 KANELL BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3041
Mailing Address - Country:US
Mailing Address - Phone:573-785-0111
Mailing Address - Fax:
Practice Address - Street 1:2700 KANELL BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3041
Practice Address - Country:US
Practice Address - Phone:573-785-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL ARTS GROUP L.L.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-01
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies