Provider Demographics
NPI:1821086547
Name:BLANKENSHIP, DENNIS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:422 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5310
Mailing Address - Country:US
Mailing Address - Phone:870-773-1111
Mailing Address - Fax:870-772-7692
Practice Address - Street 1:422 BEECH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5310
Practice Address - Country:US
Practice Address - Phone:870-773-1111
Practice Address - Fax:870-772-1354
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3130207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR107680001Medicaid
AR50512OtherBLUE CROSS BLUE SHIELD
AR50512OtherBLUE CROSS BLUE SHIELD