Individual
CARL E. BLEVINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
138 S CAROL MALONE BLVD, GRAYSON, KY 41143-1352
(606) 474-5600
(606) 474-5600
Mailing address
138 S CAROL MALONE BLVD, GRAYSON, KY 41143-1352
(606) 474-5600
(606) 474-5600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6921
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60069218
—
KY
01
—
FEIN
61-1285450
KY
Enumeration date
01/21/2007
Last updated
02/01/2012
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