Provider Demographics
NPI:1205619418
Name:BLEVINS DENTISTRY, PA
Entity type:Organization
Organization Name:BLEVINS DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-464-6162
Mailing Address - Street 1:622 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3512
Mailing Address - Country:US
Mailing Address - Phone:843-464-6162
Mailing Address - Fax:843-464-8235
Practice Address - Street 1:622 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3512
Practice Address - Country:US
Practice Address - Phone:843-464-6162
Practice Address - Fax:843-464-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental