Provider Demographics
NPI:1689942674
Name:BLANKENSHIP, DUANGKAMOL (DDS, DMD)
Entity Type:Individual
Prefix:DR
First Name:DUANGKAMOL
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:DDS, DMD
Other - Prefix:DR
Other - First Name:DUANGKAMOL
Other - Middle Name:
Other - Last Name:JIAMJARIYAPORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, DMD
Mailing Address - Street 1:1 KNEELAND ST RM 223
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1527
Mailing Address - Country:US
Mailing Address - Phone:617-636-6585
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST RM 223
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL114711223G0001X
MADF116141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice