Provider Demographics
NPI:1376821181
Name:BLANSETT, JONATHAN ANDREW (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:BLANSETT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 S PINNACLE HILLS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1415
Mailing Address - Country:US
Mailing Address - Phone:479-282-2812
Mailing Address - Fax:479-340-0068
Practice Address - Street 1:2522 S PINNACLE HILLS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1415
Practice Address - Country:US
Practice Address - Phone:479-282-2812
Practice Address - Fax:479-936-8660
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27107122300000X
AR39581223P0300X
AR3958(DDS); 37(PERIO)1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist