Provider Demographics
NPI:1225342447
Name:BLAIR, JENNIFER RAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARTINE AVE
Mailing Address - Street 2:APT 406
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-4016
Mailing Address - Country:US
Mailing Address - Phone:914-409-8851
Mailing Address - Fax:
Practice Address - Street 1:1 POWELTON RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2229
Practice Address - Country:US
Practice Address - Phone:845-476-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0550531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry