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General NPI Number Information
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NPI Number | 1477891075
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Entity Type | Organization
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Legal Business Name | BLOCKLEY DENTAL, P.C.
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 4607 DAYTON BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-2145
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Country | US
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Telephone | 423-877-8557
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Fax | 432-870-3928
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Provider Business Mailing Address
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Address Line | 4607 DAYTON BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-2145
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Country | US
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Telephone | 423-877-8557
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Fax | 432-870-3928
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HEATH THOMAS BLOCKLEY
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Credential |
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Telephone | 423-877-8557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2791
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License Number State | TN
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