Provider Demographics
NPI:1245385590
Name:JAMES E. BLANK, DDS, LLC
Entity Type:Organization
Organization Name:JAMES E. BLANK, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-399-9381
Mailing Address - Street 1:2205 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2635
Mailing Address - Country:US
Mailing Address - Phone:937-399-9381
Mailing Address - Fax:937-399-0904
Practice Address - Street 1:2205 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2635
Practice Address - Country:US
Practice Address - Phone:937-399-9381
Practice Address - Fax:937-399-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0220731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty