Provider Demographics
NPI:1689833519
Name:EDGINGTON, BLAIR
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 W 83RD ST
Mailing Address - Street 2:STE 137
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5323
Mailing Address - Country:US
Mailing Address - Phone:913-381-4700
Mailing Address - Fax:
Practice Address - Street 1:4121 W 83RD ST
Practice Address - Street 2:STE 137
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5323
Practice Address - Country:US
Practice Address - Phone:913-381-4700
Practice Address - Fax:913-381-2673
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS605541223G0001X
MO20090089361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice