MEDICARE: BLAIR JASON

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	1223P0221X	Pediatric Dentistry	NA	TN

General Provider Information

NPI Number	:	1699621037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR JASON

Provider Business Mailing Address
First Line	:	2704 MAGELLAN DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-3144
Country	:	US
Telephone Number	:	817-773-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	602-975-5253
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ BLAIR JASON ” Practice Location

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