Provider Demographics
NPI:1396187621
Name:BLOCKLEY, JOSHUA SAMUEL (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SAMUEL
Last Name:BLOCKLEY
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 1:4607 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2145
Mailing Address - Country:US
Mailing Address - Phone:423-877-8557
Mailing Address - Fax:423-870-3928
Practice Address - Street 1:4607 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-2145
Practice Address - Country:US
Practice Address - Phone:423-877-8557
Practice Address - Fax:423-870-3928
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist