Healthcare Provider Details

I. General information

NPI: 1023850708
Provider Name (Legal Business Name): CAILEN MARIE BLAIRE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 SHIELDS RD STE A
CANFIELD OH
44406-9813
US

IV. Provider business mailing address

64 LATTAVO DR
NEW CASTLE PA
16105-1844
US

V. Phone/Fax

Practice location:
  • Phone: 330-621-5957
  • Fax:
Mailing address:
  • Phone: 724-456-1287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028217
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS044688
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: