Provider Demographics
NPI:1528442589
Name:BLAIR, HEATHER (RDH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 KAYS WAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444-4455
Mailing Address - Country:US
Mailing Address - Phone:802-316-2242
Mailing Address - Fax:
Practice Address - Street 1:34 KAYS WAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444-4455
Practice Address - Country:US
Practice Address - Phone:802-316-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT015.0047046124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist