Active NPI
Ted Craig Bleckstein, D.D.S., M.S.
- Periodontics
- Afton, TN
National Provider Identifier
1407030158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 9090
- Practice address
- 1085 River Village LN
Afton, TN 37616-6219 - Phone
- (423) 639-4462
- NPI assigned
- Dec 18, 2007
- Last updated
- Sep 26, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 9090 | TN | Primary |
Addresses
Primary practice location
1085 River Village LN
Afton, TN 37616-6219
Mailing address
1085 River Village LN
Afton, TN 37616-6219
Phone (423) 639-4462
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9090 | TN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285459200000",
"number": "1407030158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1085 RIVER VILLAGE LN",
"city": "AFTON",
"state": "TN",
"postal_code": "376166219",
"telephone_number": "423-639-4462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1085 RIVER VILLAGE LN",
"city": "AFTON",
"state": "TN",
"postal_code": "376166219",
"telephone_number": "423-639-4462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLECKSTEIN",
"first_name": "TED",
"middle_name": "CRAIG",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-18",
"last_updated": "2010-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TN",
"license": "9090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Afton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.