Provider Demographics
NPI:1285722009
Name:BLAIR, STEPHEN H III (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:BLAIR
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 NORTH SHILOH ROAD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-2910
Mailing Address - Country:US
Mailing Address - Phone:662-287-3373
Mailing Address - Fax:662-287-3372
Practice Address - Street 1:3127 N. SHILOH ROAD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2910
Practice Address - Country:US
Practice Address - Phone:662-287-3373
Practice Address - Fax:662-287-3372
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2331-871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060307Medicaid