Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401006754 | VA |
NPI | 1093819013 |
---|---|
Provider Name | Dr. Jeffrey Patrick Blair |
First Address | Richmond, VA 23238-3219 |
Second Address | Richmond, VA 23238-3219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |