Jesse Blair, DDS
Individual provider Active NPI General Practice Dentistry · Fort Wayne, IN
NPI 1396290243 · NPPES record last updated Mar 25, 2021
Key facts
- NPI
- 1396290243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12013093A (IN)
- Practice address
- 2121 E Dupont Rd Ste a
Fort Wayne, IN 46825-1546 - Phone
- (843) 281-0182
- NPI assigned
- Aug 22, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013093A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jesse Blair DDS LLC | Current |
Accepting new patients | |
| JSBC Services LLC | Current |
Accepting new patients | |
| Jab Dental Inc. | Past |
Accepting new patients |
Locations
2121 E DuPont Rd
Ste A
Fort Wayne, IN 46825
Phone (260) 490-9684
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12013093A | IN | Yes |
Addresses
Primary practice location
2121 E Dupont Rd Ste a
Fort Wayne, IN 46825-1546
Mailing address
2121 E Dupont Rd Ste a
Fort Wayne, IN 46825-1546
Phone (260) 490-9684
Other providers in Fort Wayne, IN
- Sailaja M Blackmon
- Toni Walker Blackwood
- Amy Lynn Blaettner
- Johanna Blaettner
- Makayla Blain
- Nathaniel Blair
- Ryan Michael Blair
- Samantha Blair
- Emily Blake
- Thomas R Blake
All providers in Fort Wayne, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.