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General NPI Number Information
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NPI Number | 1114080777
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Entity Type | Individual
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Provider Name | REGINA LYNN BLEVINS DDS MS
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3100 WOODBURY DR
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City | WOODBURY
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State | MN
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Zip | 55129-9600
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Country | US
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Telephone | 651-714-4987
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Fax | 651-730-0415
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Provider Business Mailing Address
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Address Line | 1133 93RD ST E
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55077-4217
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Country | US
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Telephone | 651-451-3551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10244
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License Number State | MN
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