# BRENT L BLAYLOCK DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194838755
- **Authorized official:** DR. BRENT LASHLEY BLAYLOCK DDS (OWNER PRESIDENT)
- **Authorized official phone:** (919) 493-8036

## Contact information

- **Practice address:** 3206 OLD CHAPEL HILL RD STE 300, DURHAM, NC 27707-3688
- **Practice address phone:** (919) 493-8036
- **Practice address fax:** (919) 493-6060
- **Mailing address:** 3206 OLD CHAPEL HILL RD STE 300, DURHAM, NC 27707-3688
- **Mailing address phone:** (919) 493-8036
- **Mailing address fax:** (919) 493-6060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4970 | NC | Yes |

## Other

- **Enumeration date:** 08/17/2006
- **Last updated:** 07/07/2008