| Organization Name: | BRYAN KEITH BLANKENSHIP DDS PA |
| NPI Number: | 1013179258 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRYAN KEITH BLANKENSHIP (DENTIST/OWNER) |
| Mailing Address: | 5000 Sawgrass Village Cir Suite 23 Ponte Vedra |
| State: | FL US |
| Postal Code: | 320825045 |
| Phone Number: | 9042800070 |
| Fax Number: | 9042800079 |
| NPI Enumeration Date: | 06/30/2008 |
| NPI Last Update Date: | 04/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 193344 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |