Provider Demographics
NPI:1487365433
Name:MID-SOUTH TMJ AND SLEEP APNEA
Entity type:Organization
Organization Name:MID-SOUTH TMJ AND SLEEP APNEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-417-0888
Mailing Address - Street 1:1850 KIMBROUGH RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3282
Mailing Address - Country:US
Mailing Address - Phone:901-417-0888
Mailing Address - Fax:
Practice Address - Street 1:362 NEW BYHALIA RD STE 3
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3731
Practice Address - Country:US
Practice Address - Phone:901-468-7088
Practice Address - Fax:901-221-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment