Provider Demographics
NPI:1578819603
Name:PRIOUR BLALOCK, PAIGE (DDS)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:PRIOUR BLALOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:PRIOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:715 HILL COUNTY DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-257-4333
Mailing Address - Fax:830-955-5195
Practice Address - Street 1:715 HILL COUNTY DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-257-4333
Practice Address - Fax:830-955-5195
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice