Provider Demographics
NPI:1467504985
Name:BLANK, BARRY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:BLANK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2436
Mailing Address - Country:US
Mailing Address - Phone:614-864-2561
Mailing Address - Fax:614-864-2915
Practice Address - Street 1:5180 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2436
Practice Address - Country:US
Practice Address - Phone:614-864-2561
Practice Address - Fax:614-864-2915
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics