Provider Demographics
NPI:1891864245
Name:BLAIR, KAREN A (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4747
Mailing Address - Country:US
Mailing Address - Phone:630-390-9569
Mailing Address - Fax:
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 132
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8139
Practice Address - Country:US
Practice Address - Phone:630-416-8020
Practice Address - Fax:630-416-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist