Provider Demographics
NPI:1356072797
Name:BLANKENSHIP, HAYLEY (DDS)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3672 LEXINGTON AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3672 LEXINGTON AVE # 1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1321
Practice Address - Country:US
Practice Address - Phone:402-292-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty