Provider Demographics
NPI:1871812073
Name:BLAICH, GEORGE FREDERICK V (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FREDERICK
Last Name:BLAICH
Suffix:V
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:BLAICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:821 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4956
Mailing Address - Country:US
Mailing Address - Phone:573-785-6434
Mailing Address - Fax:573-785-3840
Practice Address - Street 1:821 W PINE ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4956
Practice Address - Country:US
Practice Address - Phone:573-785-6434
Practice Address - Fax:573-785-3840
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0161561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice