Healthcare Provider Details

I. General information

NPI: 1285070896
Provider Name (Legal Business Name): ALEXANDER REINHARD PHILIP BLASEIO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 SEVEN SPRINGS WAY STE 103
BRENTWOOD TN
37027-4576
US

IV. Provider business mailing address

317 SEVEN SPRINGS WAY STE 103
BRENTWOOD TN
37027-4576
US

V. Phone/Fax

Practice location:
  • Phone: 615-675-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number63494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10560
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: