Provider Demographics
NPI:1497431464
Name:BLANKESPOOR, AUSTIN JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JOHN
Last Name:BLANKESPOOR
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 1:2478 300TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247
Mailing Address - Country:US
Mailing Address - Phone:712-578-9709
Mailing Address - Fax:
Practice Address - Street 1:1302 10TH STREEET
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247
Practice Address - Country:US
Practice Address - Phone:712-476-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist