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General NPI Number Information
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NPI Number | 1306220140
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Entity Type | Organization
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Legal Business Name | BLINCOE & SHUTT PSC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 4122 SHELBYVILLE RD STE 115
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City | LOUISVILLE
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State | KY
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Zip | 40207-3206
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Country | US
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Telephone | 502-895-2210
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Fax | 502-895-0425
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Provider Business Mailing Address
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Address Line | 4122 SHELBYVILLE RD STE 115
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City | LOUISVILLE
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State | KY
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Zip | 40207-3206
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Country | US
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Telephone | 502-895-2210
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN R. BLINCOE
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Credential | DMD
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Telephone | 502-895-2210
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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