Provider Demographics
NPI:1972932796
Name:BLAIR FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BLAIR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KYRE
Authorized Official - Middle Name:MYISHA
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-255-1195
Mailing Address - Street 1:2500 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2158
Mailing Address - Country:US
Mailing Address - Phone:517-694-3111
Mailing Address - Fax:517-694-9202
Practice Address - Street 1:2500 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2158
Practice Address - Country:US
Practice Address - Phone:517-694-3111
Practice Address - Fax:517-694-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty