Provider Demographics
NPI:1194841767
Name:BLAIR, STANLEY PAUL (DMD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:PAUL
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971
Mailing Address - Country:US
Mailing Address - Phone:239-369-0019
Mailing Address - Fax:239-369-1015
Practice Address - Street 1:3003 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971
Practice Address - Country:US
Practice Address - Phone:239-369-0019
Practice Address - Fax:239-369-1015
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN011033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist