Provider Demographics
NPI:1023376597
Name:BLAIR, BETH ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:HOGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 RIVER PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4041
Mailing Address - Country:US
Mailing Address - Phone:608-222-6160
Mailing Address - Fax:608-222-6248
Practice Address - Street 1:100 RIVER PL
Practice Address - Street 2:SUITE 110
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4041
Practice Address - Country:US
Practice Address - Phone:608-222-6160
Practice Address - Fax:608-222-6248
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6856-151223P0221X
ND22061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry