Provider Demographics
NPI:1437171972
Name:BLANTON, PATRICIA L (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:BLANTON
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 1:531 FOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3007
Mailing Address - Country:US
Mailing Address - Phone:843-795-1111
Mailing Address - Fax:843-795-8275
Practice Address - Street 1:531 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3007
Practice Address - Country:US
Practice Address - Phone:843-795-1111
Practice Address - Fax:843-795-8275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102891223P0300X
SC83461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics