Organization
BLAIR PEDIATRIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL P BLAIR DMD (PRESIDENT)
(702) 485-9804
Entity
Organization
Contact information
Practice address
5360 N EAGLE RD, SUITE 103, BOISE, ID 83713-4901
(208) 938-9958
Mailing address
5360 N EAGLE RD, SUITE 103, BOISE, ID 83713-4901
(208) 938-9958
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D4550PD
ID
Other
Enumeration date
06/25/2014
Last updated
06/25/2014
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