Provider Demographics
NPI:1912165721
Name:BLAIR, HENRY KIME (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:KIME
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD BLDG H
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5518
Mailing Address - Country:US
Mailing Address - Phone:678-819-6536
Mailing Address - Fax:678-819-6531
Practice Address - Street 1:1000 JOHNSON FERRY RD BLDG H
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5518
Practice Address - Country:US
Practice Address - Phone:678-819-6536
Practice Address - Fax:678-819-6531
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0141751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery