Provider Demographics
NPI:1386803963
Name:BLAIR, JASON (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STUART XING NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4065
Mailing Address - Country:US
Mailing Address - Phone:423-476-2160
Mailing Address - Fax:423-476-2680
Practice Address - Street 1:150 STUART XING NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4065
Practice Address - Country:US
Practice Address - Phone:423-476-2160
Practice Address - Fax:423-476-2680
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2700390200000X
TNDS00000090661223P0221X
GA147351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program