# OLD TOWN GENERAL DENTISTRY & DENTURE LAB

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

## Provider details

- **NPI number:** 1942672118
- **Authorized official:** DR. JEFFREY C BLAIR DMD (DENTIST/MEMBER)
- **Authorized official phone:** (928) 634-8567

## Contact information

- **Practice address:** 542 N MAIN ST, COTTONWOOD, AZ 86326-3896
- **Practice address phone:** (928) 634-8567
- **Mailing address:** 542 N MAIN ST, COTTONWOOD, AZ 86326-3896
- **Mailing address phone:** (928) 634-8567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4038 | AZ | Yes |

## Other

- **Enumeration date:** 10/27/2015
- **Last updated:** 10/27/2015