Teddy Roger Bland Jr., DMD, MS
Individual provider Active NPI Dentist · Eustis, FL
NPI 1003008723 · NPPES record last updated Mar 31, 2008
Key facts
- NPI
- 1003008723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN 17164 (FL)
- Practice address
- 1340 E Orange Ave
Eustis, FL 32726-4343 - Phone
- (352) 735-2005
- NPI assigned
- Aug 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 17164 | FL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN 17164 | FL | Yes |
Addresses
Primary practice location
1340 E Orange Ave
Eustis, FL 32726-4343
Mailing address
1340 E Orange Ave
Eustis, FL 32726-4343
Phone (352) 735-2005
Other providers in Eustis, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.