Provider Demographics
NPI:1932839123
Name:BLACKBURN, BAYLEE ELIZABETH (DMD)
Entity Type:Individual
Prefix:
First Name:BAYLEE
Middle Name:ELIZABETH
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BRANTLEY ACRES RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37870-6104
Mailing Address - Country:US
Mailing Address - Phone:270-564-6137
Mailing Address - Fax:
Practice Address - Street 1:207 BRANTLEY ACRES RD
Practice Address - Street 2:
Practice Address - City:SPEEDWELL
Practice Address - State:TN
Practice Address - Zip Code:37870-6104
Practice Address - Country:US
Practice Address - Phone:270-564-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist