Provider Demographics
NPI:1013004712
Name:BLOUNT, DAVID BENTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENTON
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 NEW LAGRANGE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4700
Mailing Address - Country:US
Mailing Address - Phone:502-425-7068
Mailing Address - Fax:502-426-3493
Practice Address - Street 1:8013 NEW LAGRANGE RD STE 6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4700
Practice Address - Country:US
Practice Address - Phone:502-425-7068
Practice Address - Fax:502-426-3493
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice