Provider Demographics
NPI:1750454294
Name:BILLUPS, BLAKE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:T
Last Name:BILLUPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 SANDERLIN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4360
Mailing Address - Country:US
Mailing Address - Phone:901-767-3603
Mailing Address - Fax:901-761-1969
Practice Address - Street 1:5170 SANDERLIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4360
Practice Address - Country:US
Practice Address - Phone:901-767-3603
Practice Address - Fax:901-761-1969
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist