Provider Demographics
NPI:1215139704
Name:BLASH, GREG J (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:J
Last Name:BLASH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 GREEN RIVER RD
Mailing Address - Street 2:#104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7452
Mailing Address - Country:US
Mailing Address - Phone:951-279-3939
Mailing Address - Fax:
Practice Address - Street 1:2791 GREEN RIVER RD
Practice Address - Street 2:#104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7452
Practice Address - Country:US
Practice Address - Phone:951-279-3939
Practice Address - Fax:951-279-0914
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG33910122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist