Ricky Lee Bledsoe, D.M.D.
Individual provider Active NPI Dentist · Whitmire, SC
NPI 1811059504 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811059504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2153 (SC)
- Practice address
- 115 Main St
Whitmire, SC 29178-1345 - Phone
- (803) 694-2382
- Fax
- (803) 694-2383
- NPI assigned
- Dec 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 2153 | SC | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R L Bledsoe, DMD PA | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2153 | SC | Yes |
Addresses
Primary practice location
115 Main St
Whitmire, SC 29178-1345
Mailing address
115 Main St
Whitmire, SC 29178-1345
Phone (803) 694-2382
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z21539 | Medicaid | SC |
Other providers in Whitmire, SC
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.