Organization
WILMINGTON AESTHETIC FACIAL PLASTIC AND RECONSTRUCTIVE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEIDRA A BLANKS MD (OWNER)
(910) 762-1070
Entity
Organization
Contact information
Practice address
1604 PHYSICIANS DR, 103, WILMINGTON, NC 28401-7362
(910) 762-1070
(910) 762-1083
Mailing address
1604 PHYSICIANS DR, 103, WILMINGTON, NC 28401-7362
(910) 762-1070
(910) 762-1083
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
2006-00621
NC
Other
Enumeration date
07/10/2012
Last updated
07/26/2012
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