Provider Demographics
NPI:1730210394
Name:LARES-NELSON, BLANCA ESTELA (DDS)
Entity type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:ESTELA
Last Name:LARES-NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6952 SECREST CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7650
Mailing Address - Country:US
Mailing Address - Phone:303-460-1073
Mailing Address - Fax:
Practice Address - Street 1:16205 W 64TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7401
Practice Address - Country:US
Practice Address - Phone:303-940-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice