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SAMMY BRYAN BLACKSHARE DDS

>> Dentist >> Dental Providers

Registrant NPI Number: 1023183050

Individual Registrant:
 SAMMY BRYAN BLACKSHARE DDS
Gender: M
Sole Proprietor

Location and contact information for practice:
737 E 9TH  RECTOR, AR 72461 US
Tel: 870-595-3463  Fax: 870-595-3208

Contact information for business:
PO BOX 363 737 E 9TH RECTOR, AR 72461 US
Tel: 870-595-3463  Fax: 870-595-3208

Registration Information:
NPI: 1023183050
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
AR2730

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
BC BS3014523TN01
UNITED CONCORDIA840563AR01
BC BS59281AR01




HEALTH CARE JOBS AR - Page 1



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