Provider Demographics
NPI:1033723499
Name:BLANKENSHIP, COURTNEY LAHATTE (DMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LAHATTE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JACK WHITE DR STE 12
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2379
Mailing Address - Country:US
Mailing Address - Phone:423-247-6961
Mailing Address - Fax:
Practice Address - Street 1:116 JACK WHITE DR STE 12
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2379
Practice Address - Country:US
Practice Address - Phone:423-247-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist