Provider Demographics
NPI:1689730418
Name:BLEVINS, CARTER L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:L
Last Name:BLEVINS
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 1:176 SOUTHPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-4149
Mailing Address - Country:US
Mailing Address - Phone:606-679-7562
Mailing Address - Fax:606-677-2557
Practice Address - Street 1:176 SOUTHPORT DRIVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-4149
Practice Address - Country:US
Practice Address - Phone:606-679-7562
Practice Address - Fax:606-677-2557
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000217071OtherBCBS
KY60042017Medicaid
KY64042013Medicaid
KY64042013OtherMEDICAL
KY60042017Medicaid
T54052Medicare UPIN