Provider Demographics
NPI:1730894312
Name:BLAIR THOMAS DMD PLLC
Entity type:Organization
Organization Name:BLAIR THOMAS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-743-9996
Mailing Address - Street 1:3527 COVENTRY GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2837
Mailing Address - Country:US
Mailing Address - Phone:702-743-9996
Mailing Address - Fax:
Practice Address - Street 1:8285 W ARBY AVE STE 265
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2235
Practice Address - Country:US
Practice Address - Phone:702-743-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty