Healthcare Provider Details

I. General information

NPI: 1982710042
Provider Name (Legal Business Name): WILLIAM ROBERT BLEVINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 SO. FT. THOMAS AVE
FT. THOMAS KY
41075-1910
US

IV. Provider business mailing address

16 PENTLAND PL
FORT THOMAS KY
41075-1910
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-8050
  • Fax: 859-491-8056
Mailing address:
  • Phone: 859-781-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3907
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: