Organization
AESTHETIC DENTISTRY OF COLLIERVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN O BLANTON DDS (OWNER)
(901) 853-8116
Entity
Organization
Contact information
Practice address
362 NEW BYHALIA RD, SUITE #3, COLLIERVILLE, TN 38017-3731
(901) 853-8116
(901) 853-0134
Mailing address
362 NEW BYHALIA RD, SUITE #3, COLLIERVILLE, TN 38017-3731
(901) 853-8116
(901) 853-0134
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4231
TN
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
07/07/2011
Last updated
10/31/2011
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