MEDICARE: DR. CARL ALIUS BLADES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10114	GA

General Provider Information

NPI Number	:	1982616298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL ALIUS BLADES D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 796
Second Line	:
City	:	WEST POINT
State	:	GA
Zip	:	31833-0796
Country	:	US
Telephone Number	:	706-643-7731
Fax Number	:	706-643-5668

Provider Business Practice Location Address
First Line	:	808 AVENUE C
Second Line	:
City	:	WEST POINT
State	:	GA
Zip	:	31833-1641
Country	:	US
Telephone Number	:	706-643-7731
Fax Number	:	706-643-5668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/09/2007

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