BRYAN KEITH BLANKENSHIP DDS PA
Dentist at Sawgrass Village Cir, Ponte Vedra, FL

License number
Florida 193344
Category
Ambulatory Health
Type
Dental
Owner
Name: DR. BRYAN KEITH BLANKENSHIP DDS
Title: DENTIST/OWNER
Phone: (904) 280-0070
Address
Address
5000 Sawgrass Village Cir SUITE 23, Ponte Vedra, FL 32082
National Provider ID: 1013179258
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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BRYAN KEITH BLANKENSHIP, D.D.S., PA

5000 Sawgrass Vlg Cir STE 23, Ponte Vedra Beach, FL 32082

Status:
Inactive
Industry:
Dentist's Office
Inactive reason:
Voluntary Dissolution
Registration:
Aug 12, 2005
Inactive since:
Mar 26, 2012
State ID:
P05000112264
Business type:
Florida Profit Corporation
President:
Bryan K Blankenship President, inactive, 5000 Sawgrass Vlg Cir #23, Ponte Vedra Beach, FL 32082 (Physical)
Agent:
Bryan Blankenship,5000 Sawgrass Vilalge Cir, Ponte Vedra Beach, FL 32082 (Physical)
EIN:
203294786

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