Provider Demographics
NPI:1659469682
Name:BLAIR, TIMOTHY M (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
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 1:500 LENTZ DR
Mailing Address - Street 2:SUITE 90 A
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5135
Mailing Address - Country:US
Mailing Address - Phone:615-865-7176
Mailing Address - Fax:615-865-5066
Practice Address - Street 1:500 LENTZ DR
Practice Address - Street 2:SUITE 90 A
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5135
Practice Address - Country:US
Practice Address - Phone:615-865-7176
Practice Address - Fax:615-865-5066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4684122300000X, 1223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0085546OtherBCBS PROVIDER ID