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General NPI Number Information
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NPI Number | 1639736887
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Entity Type | Individual
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Provider Name | ANDREW R BLANK DMD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 205 1ST ST E
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City | CONOVER
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State | NC
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Zip | 28613-2103
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Country | US
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Telephone | 828-464-2401
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Fax | 828-464-2416
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Provider Business Mailing Address
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Address Line | 70 CHARLOTTE ANN LN
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City | HICKORY
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State | NC
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Zip | 28601-8802
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Country | US
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Telephone | 704-223-0857
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11358
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License Number State | NC
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