Provider Demographics
NPI:1932395639
Name:BLOURCHIAN, ALIREZA ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:ALLEN
Last Name:BLOURCHIAN
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 1:155 COVER DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-591-4490
Mailing Address - Fax:615-591-4412
Practice Address - Street 1:155 COVER DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-591-4490
Practice Address - Fax:615-591-4412
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS5340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDS5340OtherSTATE OF TENNESSEE
TN3206940Medicaid
BB2768856OtherDEA