Provider Demographics
NPI:1770798704
Name:BLAND, PAUL SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:BLAND
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 1:197 WILLIFORD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 WILLOW TREE CIR
Practice Address - Street 2:101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6376
Practice Address - Country:US
Practice Address - Phone:901-756-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics