Organization
D. BLAINE LEEDS DBLDDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANNY BLAINE LEEDS DDS (DENTIST)
(479) 754-3357
Entity
Organization
Contact information
Practice address
1101 E POPLAR ST, CLARKSVILLE, AR 72830-4420
(479) 754-3357
(479) 754-0167
Mailing address
1101 E POPLAR ST, CLARKSVILLE, AR 72830-4420
(479) 754-3357
(479) 754-0167
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR3197
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136700608
—
AR
01
—
485722
UCCI
—
01
—
5T397
BLUE CROSS/ BLUE SHIELD
AR
Enumeration date
01/05/2009
Last updated
01/05/2009
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