Provider Demographics
NPI:1326151978
Name:BLAYLOCK, BRENT LASHLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LASHLEY
Last Name:BLAYLOCK
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 1:3206 OLD CHAPEL HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3688
Mailing Address - Country:US
Mailing Address - Phone:919-493-8036
Mailing Address - Fax:919-493-6060
Practice Address - Street 1:3206 OLD CHAPEL HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3688
Practice Address - Country:US
Practice Address - Phone:919-493-8036
Practice Address - Fax:919-493-6060
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice