Provider Demographics
NPI:1275657165
Name:BLAIR, EDSEL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDSEL
Middle Name:DEAN
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 WINDMILL WATCH DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2962
Mailing Address - Country:US
Mailing Address - Phone:804-746-1085
Mailing Address - Fax:804-559-5953
Practice Address - Street 1:8220 WINDMILL WATCH DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2962
Practice Address - Country:US
Practice Address - Phone:804-746-1085
Practice Address - Fax:804-559-5953
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice