Provider Demographics
NPI:1528233566
Name:BLEVINS, JOHN J (DDS PC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 NORTH MAIN STREET
Mailing Address - Street 2:PO BOX 127
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS183611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72112Medicare UPIN