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General NPI Number Information
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NPI Number | 1407030158
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Entity Type | Individual
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Provider Name | TED CRAIG BLECKSTEIN D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 09/26/2010
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Provider Practice Location Address
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Address Line | 1085 RIVER VILLAGE LN
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City | AFTON
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State | TN
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Zip | 37616-6219
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Country | US
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Telephone | 423-639-4462
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 RIVER VILLAGE LN
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City | AFTON
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State | TN
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Zip | 37616-6219
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Country | US
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Telephone | 423-639-4462
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 9090
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License Number State | TN
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