Individual
SAMMY BRYAN BLACKSHARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
737 E 9TH, RECTOR, AR 72461
(870) 595-3463
(870) 595-3208
Mailing address
PO BOX 363, 737 E 9TH, RECTOR, AR 72461
(870) 595-3463
(870) 595-3208
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2730
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3014523
BC BS
TN
01
—
59281
BC BS
AR
01
—
840563
UNITED CONCORDIA
AR
Enumeration date
11/22/2006
Last updated
06/26/2019
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