Individual
MICHELE LYNN BLOXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4257 W 3RD ST, DAYTON, OH 45417-1406
(937) 268-1665
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 562-4461
(719) 584-7694
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-022714
OH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2901018969
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1635834
UNITED CONCORDIA
—
01
—
381908328020
DENTAL BLUE
—
05
—
4667047
—
MI
01
—
88096MI
WADSWORTH
—
01
—
88123MI
BAYSIDE
—
01
—
88170MI
OUTER DRIVE
—
01
—
88171MI
COMMERCE
—
01
—
D801095
BLUE CROSS
—
Enumeration date
10/11/2005
Last updated
03/19/2008
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