Provider Demographics
NPI:1073290185
Name:BLAIR, SHINEILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHINEILLE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3789
Mailing Address - Country:US
Mailing Address - Phone:954-358-7511
Mailing Address - Fax:
Practice Address - Street 1:719 LANIER AVE W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7634
Practice Address - Country:US
Practice Address - Phone:770-615-0999
Practice Address - Fax:770-731-2385
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist