Provider Demographics
NPI:1962589341
Name:BLAHA, DAVID A (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BLAHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1001 S 70TH ST
Mailing Address - Street 2:#105
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-7905
Mailing Address - Country:US
Mailing Address - Phone:402-486-1001
Mailing Address - Fax:402-486-3029
Practice Address - Street 1:1001 S 70TH ST
Practice Address - Street 2:#105
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-7905
Practice Address - Country:US
Practice Address - Phone:402-486-1001
Practice Address - Fax:402-486-3029
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE52141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery