Organization
OLD TOWN GENERAL DENTISTRY & DENTURE LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY C BLAIR DMD (DENTIST/MEMBER)
(928) 634-8567
Entity
Organization
Contact information
Practice address
542 N MAIN ST, COTTONWOOD, AZ 86326-3896
(928) 634-8567
Mailing address
542 N MAIN ST, COTTONWOOD, AZ 86326-3896
(928) 634-8567
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4038
AZ
Other
Enumeration date
10/27/2015
Last updated
10/27/2015
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