Beau D Blankenship, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22816 Issued in TX

Legal business name

BEAU D BLANKENSHIP, DDS, PC

Doing business as

Lakeline Mall Family Dental

Practice address

11200 Lakeline Mall Dr
#B1
Cedar Park, TX 78613-1501

Phone

(512) 448-4867

Fax

(512) 335-7668

NPI assigned

Mar 1, 2012

Last updated

Mar 1, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Beau D Blankenship, D.D.S.

Title

Owner/President

Phone

(210) 722-9274

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeline Mall Family Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1104190594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SLEDGE DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787346373",
            "telephone_number": "210-722-9274",
            "fax_number": "512-335-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "#B1",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131501",
            "telephone_number": "512-448-4867",
            "fax_number": "512-335-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAU D BLANKENSHIP, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-01",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "BLANKENSHIP",
        "authorized_official_first_name": "BEAU",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "210-722-9274",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181540911",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeline Mall Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Christian Lund Beard
• Madeline Beaulne-Ortiz, LCSW
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• Jacqueline Elizabeth Beeding, SLP
• Beeyond Health and Wellness LLC
• Mahmuda Begum, MD

• General Practice Dentistry in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.