Provider Demographics
NPI:1588786594
Name:BLESSITT, KEITH (DMD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BLESSITT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 TAMIAMI TRL N STE B
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3421
Mailing Address - Country:US
Mailing Address - Phone:941-966-7226
Mailing Address - Fax:941-966-5251
Practice Address - Street 1:2420 TAMIAMI TRL N STE B
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3421
Practice Address - Country:US
Practice Address - Phone:941-966-7226
Practice Address - Fax:941-966-5251
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics