Provider Demographics
NPI:1659864544
Name:BLAKENEY, STEVEN PARKER (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PARKER
Last Name:BLAKENEY
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 1:12182 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3125
Mailing Address - Country:US
Mailing Address - Phone:228-832-4224
Mailing Address - Fax:228-832-4896
Practice Address - Street 1:12182 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3125
Practice Address - Country:US
Practice Address - Phone:228-832-4224
Practice Address - Fax:228-832-4896
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3991-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice