Provider Demographics
NPI:1144880154
Name:BLACKSHARE, DANIEL MILLER (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MILLER
Last Name:BLACKSHARE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:RECTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72461-0284
Mailing Address - Country:US
Mailing Address - Phone:870-595-4220
Mailing Address - Fax:
Practice Address - Street 1:737 E 9TH ST
Practice Address - Street 2:
Practice Address - City:RECTOR
Practice Address - State:AR
Practice Address - Zip Code:72461-2705
Practice Address - Country:US
Practice Address - Phone:870-595-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist