Provider Demographics
NPI:1417268731
Name:BLAIR, CAMERON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
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 1:4809 N BELT LINE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3101
Mailing Address - Country:US
Mailing Address - Phone:696-076-6194
Mailing Address - Fax:
Practice Address - Street 1:388 BETHANY RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-6210
Practice Address - Country:US
Practice Address - Phone:310-877-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89831223G0001X
LA61181223G0001X
TX280511223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice