Provider Demographics
NPI:1639736887
Name:BLANK, ANDREW R (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:BLANK
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 1:70 CHARLOTTE ANN LN
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8802
Mailing Address - Country:US
Mailing Address - Phone:704-223-0857
Mailing Address - Fax:
Practice Address - Street 1:205 1ST ST E
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2103
Practice Address - Country:US
Practice Address - Phone:828-464-2401
Practice Address - Fax:828-464-2416
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice