Provider Demographics
NPI:1548976871
Name:BLASEK, ANDREW LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEE
Last Name:BLASEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 FORT HILL CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2306
Mailing Address - Country:US
Mailing Address - Phone:267-664-4231
Mailing Address - Fax:
Practice Address - Street 1:1000 E WELSH RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2316
Practice Address - Country:US
Practice Address - Phone:215-643-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0438921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice