Provider Demographics
NPI:1659984029
Name:SMITH, BLAIR LAWRENCE (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:LAWRENCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 LITHO PL STE 300
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2538
Mailing Address - Country:US
Mailing Address - Phone:910-485-7070
Mailing Address - Fax:
Practice Address - Street 1:5710 ROCKFISH RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1847
Practice Address - Country:US
Practice Address - Phone:910-424-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice