Individual
DEREK EMERSON BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
2100 STANTONSBURG RD, GREENVILLE, NC 27834-2818
(252) 744-4618
(252) 744-4614
Mailing address
2100 STANTONSBURG RD, GREENVILLE, NC 27834-2818
(252) 744-4618
(252) 744-4614
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/02/2010
Last updated
06/02/2010
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