MEDICARE: DR. KYRE BLAIR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901019997	MI

General Provider Information

NPI Number	:	1417184003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYRE BLAIR DDS

Provider Business Mailing Address
First Line	:	2500 CEDAR ST
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48842-2158
Country	:	US
Telephone Number	:	517-694-3111
Fax Number	:	517-694-9202

Provider Business Practice Location Address
First Line	:	2500 CEDAR ST
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48842-2158
Country	:	US
Telephone Number	:	517-694-3111
Fax Number	:	517-694-9202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	11/28/2012

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Directions to “ DR. KYRE BLAIR DDS” Practice Location

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