Basic Information
| Provider Information | |||||||||
| NPI: | 1821384454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKLEDGE | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372063605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156208647 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3304 COURTNEY CT | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372182708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152448165 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 9327 | TN | Y | Dental Providers | Dentist | General Practice |
No ID Information.