Healthcare Provider Details

I. General information

NPI: 1982978391
Provider Name (Legal Business Name): BLAIR ENDODONTICS AND MICROSURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 LAKEMONT PARK BLVD
ALTOONA PA
16602-5943
US

IV. Provider business mailing address

175 LAKEMONT PARK BLVD
ALTOONA PA
16602-5943
US

V. Phone/Fax

Practice location:
  • Phone: 814-201-2102
  • Fax:
Mailing address:
  • Phone: 814-201-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS036597
License Number StatePA

VIII. Authorized Official

Name: DR. MINA SAAD
Title or Position: DENTIST
Credential:
Phone: 814-201-2102