Provider Demographics
NPI:1992017131
Name:RANDY N BLAIR DDS PLLC
Entity Type:Organization
Organization Name:RANDY N BLAIR DDS PLLC
Other - Org Name:DENTAL 32
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY BLAIR
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-308-8068
Mailing Address - Street 1:343 WELLSIAN WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4116
Mailing Address - Country:US
Mailing Address - Phone:509-308-8068
Mailing Address - Fax:
Practice Address - Street 1:3095 KEENE RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-308-8068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-03
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 600897841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty