Provider Demographics
NPI:1972512028
Name:BLAYLOCK, N BILL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:N
Middle Name:BILL
Last Name:BLAYLOCK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:131 FOY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-443-6443
Mailing Address - Fax:252-443-0043
Practice Address - Street 1:131 FOY DR
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2448
Practice Address - Country:US
Practice Address - Phone:252-443-6443
Practice Address - Fax:252-443-0043
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC47471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990846Medicaid