Provider Demographics
NPI:1639416514
Name:BLAND, NICHOLAS NORWOOD (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:NORWOOD
Last Name:BLAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-643-2196
Mailing Address - Fax:910-907-7004
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:910-907-7004
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice