Provider Demographics
NPI:1033268719
Name:BLEVINS, DONALD E (DDS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:E
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-771-4364
Mailing Address - Fax:406-268-3720
Practice Address - Street 1:2100 16TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-771-4364
Practice Address - Fax:406-268-3720
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDENDENLIC12661223G0001X
MT4209394481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12664OtherBCBS