Provider Demographics
NPI:1821140344
Name:BLANKENSHIP, ROSELYN L (RDH)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:L
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAUREN DR
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-8616
Mailing Address - Country:US
Mailing Address - Phone:423-345-3096
Mailing Address - Fax:
Practice Address - Street 1:201 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2919
Practice Address - Country:US
Practice Address - Phone:423-272-7641
Practice Address - Fax:
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
TNDH0000004637124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist