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General NPI Number Information
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NPI Number | 1154793982
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Entity Type | Organization
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Legal Business Name | WHITE & BLANSETT PERIODONTICS & DENTAL IMPLANTS
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 201 N 34TH ST
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City | ROGERS
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State | AR
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Zip | 72756-0352
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Country | US
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Telephone | 479-631-6074
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Fax | 479-936-8660
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Provider Business Mailing Address
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Address Line | 201 N 34TH ST
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City | ROGERS
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State | AR
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Zip | 72756-0352
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Country | US
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Telephone | 479-631-6074
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Fax | 479-936-8660
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. JONATHAN ANDREW BLANSETT
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Credential | DDS, PLLC
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Telephone | 479-631-6074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3958
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License Number State | AR
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