Provider Demographics
NPI:1427382910
Name:BLAIR, RANDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
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 1:3095 KEENE RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7703
Mailing Address - Country:US
Mailing Address - Phone:509-943-3232
Mailing Address - Fax:
Practice Address - Street 1:343 WELLSIAN WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-943-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60089784122300000X
ORD9348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist