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General NPI Number Information
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NPI Number | 1376821181
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Entity Type | Individual
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Provider Name | JONATHAN ANDREW BLANSETT DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 2522 S PINNACLE HILLS PKWY STE 102
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City | ROGERS
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State | AR
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Zip | 72758-1415
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Country | US
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Telephone | 479-282-2812
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Fax | 479-936-8660
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Provider Business Mailing Address
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Address Line | 2522 S PINNACLE HILLS PKWY STE 102
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City | ROGERS
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State | AR
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Zip | 72758-1415
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Country | US
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Telephone | 479-282-2812
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Fax | 479-340-0068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27107
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License Number State | TX
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3958(DDS); 37(PERIO)
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License Number State | AR
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