Provider Demographics
NPI:1205046828
Name:BLUM & TINSLEY PC
Entity type:Organization
Organization Name:BLUM & TINSLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-360-5566
Mailing Address - Street 1:700 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3946
Mailing Address - Country:US
Mailing Address - Phone:405-360-5566
Mailing Address - Fax:405-360-2746
Practice Address - Street 1:700 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3946
Practice Address - Country:US
Practice Address - Phone:405-360-5566
Practice Address - Fax:405-360-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4455122300000X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No122300000XDental ProvidersDentistGroup - Single Specialty