Lowell Dale Blevins, DDS
Individual provider Active NPI Dentist · Clarksville, TN
NPI 1386702249 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1386702249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1483 (TN)
- Practice address
- 1692 Fort Cambell Blvd
Clarksville, TN 37042 - Phone
- (931) 552-7745
- Fax
- (931) 645-3545
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1483 | TN | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1483 | TN | Yes |
Addresses
Primary practice location
1692 Fort Cambell Blvd
Clarksville, TN 37042
Mailing address
1692 Fort Cambell Blvd
Clarksville, TN 37042
Phone (931) 552-7745
Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.