Healthcare Provider Details

I. General information

NPI: 1124334883
Provider Name (Legal Business Name): MICHAEL L. BLANSCET D.D.S., P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 MCCAIN BLVD STE 201
NORTH LITTLE ROCK AR
72116-7612
US

IV. Provider business mailing address

2504 MCCAIN BLVD STE 201
NORTH LITTLE ROCK AR
72116-7612
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-8002
  • Fax: 501-758-1839
Mailing address:
  • Phone: 501-758-8002
  • Fax: 501-758-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberAR 3371
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL LANE BLANSCET
Title or Position: DENTIST ENDODONTIST
Credential: DDS MS
Phone: 501-758-8002