Provider Demographics
NPI:1659469682
Name:BLAIR, TIMOTHY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
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 1:500 LENTZ DR
Mailing Address - Street 2:SUITE 90 A
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5135
Mailing Address - Country:US
Mailing Address - Phone:615-865-7176
Mailing Address - Fax:615-865-5066
Practice Address - Street 1:500 LENTZ DR
Practice Address - Street 2:SUITE 90 A
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5135
Practice Address - Country:US
Practice Address - Phone:615-865-7176
Practice Address - Fax:615-865-5066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4684122300000X, 1223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0085546OtherBCBS PROVIDER ID