Healthcare Provider Details

I. General information

NPI: 1104898501
Provider Name (Legal Business Name): DAVID FORD BLANDEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E POTTAWATAMIE ST
TECUMSEH MI
49286-2016
US

IV. Provider business mailing address

416 E POTTAWATAMIE ST
TECUMSEH MI
49286-2016
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-7434
  • Fax: 517-423-5301
Mailing address:
  • Phone: 517-423-7434
  • Fax: 517-423-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: