Randall Parley Blair, DMD
Individual provider Active NPI Pediatric Dentistry · Meridian, ID
NPI 1659546174 · NPPES record last updated Feb 9, 2021
Key facts
- NPI
- 1659546174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- D4550PD (ID)
- Practice address
- 37 W Archerfield St Ste 100
Meridian, ID 83646-6587 - Phone
- (208) 938-9958
- Fax
- (208) 298-0646
- NPI assigned
- Apr 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| D4550PD | ID | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blair Pediatric Dentistry PC | Pediatric Dentistry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D4550PD | ID | Yes |
Addresses
Primary practice location
37 W Archerfield St Ste 100
Meridian, ID 83646-6587
Mailing address
37 W Archerfield St Ste 100
Meridian, ID 83646-6587
Phone (208) 938-9958
Other names
- Dr. Randy Blair
Other providers in Meridian, ID
- Amy Blackledge
- Blackmer Podiatry
- Blackrock Orthopedic Specialists LLC
- Lacee Danielle Blackstone
- Chad Blair
- Carolyn Blaisdell
- Lloyd W. Blake
- Sheila Marie Blewett
- Marijke Blokker
- Blood on the Run Inc.
All providers in Meridian, ID · Pediatric Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 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.