Provider Demographics
NPI:1407069370
Name:BLEDSOE, WILLIAM STEVENSON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STEVENSON
Last Name:BLEDSOE
Suffix:JR
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 1:775 EAST BROOKHAVEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-682-3100
Mailing Address - Fax:901-682-9848
Practice Address - Street 1:775 EAST BROOKHAVEN CIRCLE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-682-3100
Practice Address - Fax:901-682-9848
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDS31051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTNDS3105OtherSTATE LICENCE NUMBER