Provider Demographics
NPI:1427600980
Name:BLANKENBURG, DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BLANKENBURG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 W 96TH AVE APT 1220
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5714
Mailing Address - Country:US
Mailing Address - Phone:859-468-5179
Mailing Address - Fax:
Practice Address - Street 1:200 W COUNTY LINE RD STE 270
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2342
Practice Address - Country:US
Practice Address - Phone:303-791-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002040341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice