Provider Demographics
NPI:1407866460
Name:JOHN J BLEVINS DDS PC
Entity Type:Organization
Organization Name:JOHN J BLEVINS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:717-792-0484
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:286 NORTH MAIN STREET
Mailing Address - City:YORK NEW SALEM
Mailing Address - State:PA
Mailing Address - Zip Code:17371
Mailing Address - Country:US
Mailing Address - Phone:717-792-0484
Mailing Address - Fax:717-792-9723
Practice Address - Street 1:286 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:YORK NEW SALEM
Practice Address - State:PA
Practice Address - Zip Code:17371
Practice Address - Country:US
Practice Address - Phone:717-792-0484
Practice Address - Fax:717-792-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS183611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T72112Medicare UPIN