Provider Demographics
NPI:1841784923
Name:BLEVINS, NICHOLAS THEODORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THEODORE
Last Name:BLEVINS
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 1:5507 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2913
Mailing Address - Country:US
Mailing Address - Phone:440-473-3338
Mailing Address - Fax:
Practice Address - Street 1:5507 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2913
Practice Address - Country:US
Practice Address - Phone:440-473-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0254681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice