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General NPI Number Information
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NPI Number | 1720416290
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Entity Type | Organization
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Legal Business Name | JEFFREY P BLAIR, DDS, PC
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 12205 GAYTON RD
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City | HENRICO
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State | VA
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Zip | 23238-3212
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Country | US
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Telephone | 804-741-1400
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Fax | 804-741-7700
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Provider Business Mailing Address
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Address Line | 12205 GAYTON RD
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City | HENRICO
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State | VA
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Zip | 23238-3212
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Country | US
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Telephone | 804-741-1400
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Fax | 804-741-7700
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JEFFERY P BLAIR
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Credential | DDS
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Telephone | 804-741-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401006754
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License Number State | VA
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