Provider Demographics
NPI:1891906038
Name:CONRAD, BLAINE HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:HARRIS
Last Name:CONRAD
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 1:22 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-1273
Mailing Address - Country:US
Mailing Address - Phone:740-983-3151
Mailing Address - Fax:
Practice Address - Street 1:22 MILLER AVE
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-1273
Practice Address - Country:US
Practice Address - Phone:740-983-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice