NPIMap

Organization Active NPI

Aesthetic Dentistry of Collierville PLLC

  • Dentist
  • Collierville, TN
National Provider Identifier
1114214426
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4231 Issued in TN
Legal business name
AESTHETIC DENTISTRY OF COLLIERVILLE PLLC
Practice address
362 New Byhalia Rd
Suite #3
Collierville, TN 38017-3731
Phone
(901) 853-8116
Fax
(901) 853-0134
NPI assigned
Jul 7, 2011
Last updated
Oct 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alan O Blanton, DDSNPI 1750494951
Title
Owner
Phone
(901) 853-8116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X NU
Dentist 122300000X 4231 TN Primary

Addresses

Primary practice location

362 New Byhalia Rd
Suite #3
Collierville, TN 38017-3731

Mailing address

362 New Byhalia Rd
Suite #3
Collierville, TN 38017-3731
Phone (901) 853-8116

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1114214426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 NEW BYHALIA RD",
            "address_2": "SUITE #3",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380173731",
            "telephone_number": "901-853-8116",
            "fax_number": "901-853-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 NEW BYHALIA RD",
            "address_2": "SUITE #3",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380173731",
            "telephone_number": "901-853-8116",
            "fax_number": "901-853-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC DENTISTRY OF COLLIERVILLE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-853-8116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "4231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collierville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.