Provider Demographics
NPI:1760562607
Name:BLAIR, DONALD STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STANLEY
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 1:2848 COUNTY ROAD BB
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8862
Mailing Address - Country:US
Mailing Address - Phone:608-839-9200
Mailing Address - Fax:608-839-8400
Practice Address - Street 1:2848 COUNTY ROAD BB
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-8862
Practice Address - Country:US
Practice Address - Phone:608-839-9200
Practice Address - Fax:608-839-8400
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice