Organization
BEAU D BLANKENSHIP, DDS, PC
Active
Other names
Lakeline Mall Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEAU D BLANKENSHIP D.D.S. (OWNER/PRESIDENT)
(210) 722-9274
Entity
Organization
Contact information
Practice address
11200 LAKELINE MALL DR, #B1, CEDAR PARK, TX 78613-1501
(512) 448-4867
(512) 335-7668
Mailing address
1215 SLEDGE DR, AUSTIN, TX 78734-6373
(210) 722-9274
(512) 335-7668
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22816
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181540911
—
TX
Enumeration date
03/01/2012
Last updated
03/01/2012
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