Healthcare Provider Details

I. General information

NPI: 1144907254
Provider Name (Legal Business Name): KRISTIN NICOLE BLAIR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 IMMOKALEE RD STE 102
NAPLES FL
34119-1483
US

IV. Provider business mailing address

7308 MARLBROOK DR
CHARLOTTE NC
28212-4770
US

V. Phone/Fax

Practice location:
  • Phone: 239-316-3763
  • Fax:
Mailing address:
  • Phone: 980-428-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123130
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: