Provider Demographics
NPI:1750494951
Name:BLANTON, ALAN O (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:O
Last Name:BLANTON
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 1:362 NEW BYHALIA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3731
Mailing Address - Country:US
Mailing Address - Phone:901-853-8116
Mailing Address - Fax:901-853-0134
Practice Address - Street 1:362 NEW BYHALIA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3731
Practice Address - Country:US
Practice Address - Phone:901-853-8116
Practice Address - Fax:901-853-0134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0042311223G0001X
TNDS000042311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice