Provider Demographics
NPI:1912066713
Name:FADEM, BLAIR WASHBURN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:WASHBURN
Last Name:FADEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:735 E OHIO AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3437
Mailing Address - Country:US
Mailing Address - Phone:760-294-7450
Mailing Address - Fax:760-294-7450
Practice Address - Street 1:735 E OHIO AVE STE 202
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3437
Practice Address - Country:US
Practice Address - Phone:760-294-7450
Practice Address - Fax:760-294-7450
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics