Provider Demographics
NPI:1417974361
Name:BLALOCK, DANA LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:BLALOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 PHYSICIANS DR # B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5719
Mailing Address - Country:US
Mailing Address - Phone:843-494-5004
Mailing Address - Fax:866-462-0121
Practice Address - Street 1:3464 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4820
Practice Address - Country:US
Practice Address - Phone:843-559-3530
Practice Address - Fax:843-559-2693
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice