Provider Demographics
NPI:1972644938
Name:BLOCKLEY, HEATH THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:THOMAS
Last Name:BLOCKLEY
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 1:4147 MOUNTAIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3403
Mailing Address - Country:US
Mailing Address - Phone:423-877-9582
Mailing Address - Fax:
Practice Address - Street 1:4607 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-2145
Practice Address - Country:US
Practice Address - Phone:423-877-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice