Provider Demographics
NPI:1447698188
Name:BLEVINS, EMILY BAUSCH (DMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:BAUSCH
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BAUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:316 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1550
Mailing Address - Country:US
Mailing Address - Phone:606-783-7701
Mailing Address - Fax:
Practice Address - Street 1:316 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1550
Practice Address - Country:US
Practice Address - Phone:606-783-7701
Practice Address - Fax:606-783-6847
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100248160Medicaid
KY9310OtherLICENSE NUMBER
KYK199031 (MOREHEAD)Medicare PIN
KY7100248160Medicaid