Organization
CARTER L BLEVINS DMD
Active
Organization
CARTER L BLEVINS DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARTER L BLEVINS DMD (OWNER ORAL SURGEON)
(606) 679-7562
Entity
Organization
Contact information
Practice address
176 SOUTHPORT DRIVE, SOMERSET, KY 42501-4149
(606) 679-7562
(606) 677-2557
Mailing address
176 SOUTHPORT DRIVE, SOMERSET, KY 42501-4149
(606) 679-7562
(606) 677-2557
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4201
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217071
BCBS
KY
05
—
60042017
—
KY
01
—
64042013
MEDICAID MEDICAL
KY
Enumeration date
02/08/2007
Last updated
02/07/2011
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