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General NPI Number Information
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NPI Number | 1295096618
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Entity Type | Organization
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Legal Business Name | BILL BLANDFORD DDS PC
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 4849 GREENVILLE AVE SUITE 173
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City | DALLAS
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State | TX
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Zip | 75206-4130
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Country | US
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Telephone | 214-369-9966
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Fax | 214-368-0809
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Provider Business Mailing Address
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Address Line | 4849 GREENVILLE AVE SUITE 173
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City | DALLAS
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State | TX
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Zip | 75206-4130
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Country | US
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Telephone | 214-369-9966
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Fax | 214-368-0809
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Authorized Official
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Title or Position | OWNER
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Name | DR. BILL BLANDFORD
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Credential |
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Telephone | 214-369-9966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 11881
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License Number State | TX
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