Provider Demographics
NPI:1710010335
Name:BLANDFORD, WILLIAM
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BLANDFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BLANDFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2627
Mailing Address - Country:US
Mailing Address - Phone:979-968-5813
Mailing Address - Fax:979-968-5815
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2627
Practice Address - Country:US
Practice Address - Phone:979-968-5813
Practice Address - Fax:979-968-5815
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice