MEDICARE: DR. WILLIAM ROBERT BLEVINS DMD

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	122300000X	Dentist	3907	KY

General Provider Information

NPI Number	:	1982710042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ROBERT BLEVINS DMD

Provider Business Mailing Address
First Line	:	16 PENTLAND PL
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1910
Country	:	US
Telephone Number	:	859-781-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1136 SO. FT. THOMAS AVE
Second Line	:
City	:	FT. THOMAS
State	:	KY
Zip	:	41075-1910
Country	:	US
Telephone Number	:	859-441-8050
Fax Number	:	859-491-8056

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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