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General NPI Number Information
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NPI Number | 1679699383
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Entity Type | Individual
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Provider Name | SUSAN D BLANKENSHIP DMD INC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 35036 US HIGHWAY 19 N
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City | PALM HARBOR
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State | FL
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Zip | 34684-1925
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Country | US
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Telephone | 727-446-4699
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Fax | 727-771-6804
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Provider Business Mailing Address
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Address Line | 35036 US HIGHWAY 19 N
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City | PALM HARBOR
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State | FL
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Zip | 34684-1925
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Country | US
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Telephone | 727-446-4699
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Fax | 727-771-6804
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN0013950
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License Number State | FL
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