Provider Demographics
NPI:1154660819
Name:BLANKS, TERRY CLEVE JR (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:CLEVE
Last Name:BLANKS
Suffix:JR
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 S DEXTER AVE
Mailing Address - Street 2:P.O.BOX 3544
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6619
Mailing Address - Country:US
Mailing Address - Phone:386-738-2002
Mailing Address - Fax:386-738-9523
Practice Address - Street 1:895 S. DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-738-2002
Practice Address - Fax:386-738-9523
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0005526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist