Provider Demographics
NPI:1154548394
Name:BLANK, DON S (DDS)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:S
Last Name:BLANK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 NORRIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001
Mailing Address - Country:US
Mailing Address - Phone:308-345-6760
Mailing Address - Fax:308-345-6761
Practice Address - Street 1:811 NORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001
Practice Address - Country:US
Practice Address - Phone:308-345-6760
Practice Address - Fax:308-345-6761
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE470471311001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice