Healthcare Provider Details

I. General information

NPI: 1275500183
Provider Name (Legal Business Name): WILLIAM STEPHEN BLOOD D.D.S. MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD #600
NORTH OLMSTED OH
44070-3222
US

IV. Provider business mailing address

26777 LORAIN RD #600
NORTH OLMSTED OH
44070-3222
US

V. Phone/Fax

Practice location:
  • Phone: 440-734-3131
  • Fax: 440-734-3466
Mailing address:
  • Phone: 440-734-3131
  • Fax: 440-734-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number35068129
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.018698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: