Healthcare Provider Details

I. General information

NPI: 1285767038
Provider Name (Legal Business Name): HERMAN A BLAIR DMD MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 NICHOLASVILLE ROAD
LEXINGTON KY
40503
US

IV. Provider business mailing address

1636 NICHOLASVILLE ROAD
LEXINGTON KY
40503
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-1124
  • Fax: 859-277-1593
Mailing address:
  • Phone: 859-277-1124
  • Fax: 859-277-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3638
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: