Provider Demographics
NPI:1831432558
Name:BLANKENSHIP, HEATHER YVONNE (RDA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:YVONNE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 SIMMS ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6316
Mailing Address - Country:US
Mailing Address - Phone:501-940-6216
Mailing Address - Fax:
Practice Address - Street 1:2014 SIMMS ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6316
Practice Address - Country:US
Practice Address - Phone:501-940-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9633126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant