Provider Demographics
NPI:1003889874
Name:BLANEY, JAMES MICKAEL (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICKAEL
Last Name:BLANEY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2304
Mailing Address - Country:US
Mailing Address - Phone:615-851-9111
Mailing Address - Fax:
Practice Address - Street 1:306 BLUEBIRD DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2304
Practice Address - Country:US
Practice Address - Phone:615-851-9111
Practice Address - Fax:615-851-1608
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000079491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics