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General NPI Number Information
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NPI Number | 1659546174
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Entity Type | Individual
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Provider Name | RANDALL PARLEY BLAIR DMD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 37 W ARCHERFIELD ST STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-6587
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Country | US
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Telephone | 208-938-9958
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Fax | 208-298-0646
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Provider Business Mailing Address
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Address Line | 37 W ARCHERFIELD ST STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-6587
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Country | US
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Telephone | 208-938-9958
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Fax | 208-298-0646
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D4550PD
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License Number State | ID
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