Provider Demographics
NPI:1124334883
Name:MICHAEL L. BLANSCET D.D.S., P.L.C.
Entity type:Organization
Organization Name:MICHAEL L. BLANSCET D.D.S., P.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:BLANSCET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:501-758-8002
Mailing Address - Street 1:2504 MCCAIN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7612
Mailing Address - Country:US
Mailing Address - Phone:501-758-8002
Mailing Address - Fax:501-758-1839
Practice Address - Street 1:2504 MCCAIN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7612
Practice Address - Country:US
Practice Address - Phone:501-758-8002
Practice Address - Fax:501-758-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 33711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty