Old Town General Dentistry & Denture Lab

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4038 Issued in AZ

Legal business name

OLD TOWN GENERAL DENTISTRY & DENTURE LAB

Practice address

542 N Main St
Cottonwood, AZ 86326-3896

Phone

(928) 634-8567

NPI assigned

Oct 27, 2015

Last updated

Oct 27, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey C Blair, DMDNPI 1730133125

Title

Dentist/Member

Phone

(928) 634-8567

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Colin Blair, DMD

  • Dentist
  • Cottonwood, AZ
  • NPI 1730133125
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1942672118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "542 N MAIN ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863263896",
            "telephone_number": "928-634-8567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 N MAIN ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863263896",
            "telephone_number": "928-634-8567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN GENERAL DENTISTRY & DENTURE LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-27",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DENTIST/MEMBER",
        "authorized_official_telephone_number": "928-634-8567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D4038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.