MEDICARE: SUSAN D BLANKENSHIP DMD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN0013950	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679699383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN D BLANKENSHIP DMD INC

Provider Business Mailing Address
First Line	:	35036 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1925
Country	:	US
Telephone Number	:	727-446-4699
Fax Number	:	727-771-6804

Provider Business Practice Location Address
First Line	:	35036 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1925
Country	:	US
Telephone Number	:	727-446-4699
Fax Number	:	727-771-6804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	10/03/2023

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