Organization Name: | W.R. BLACKWELDER D.D.S. , INC. |
NPI Number: | 1144439993 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WALLACE R. BLACKWELDER (PRESIDENT) |
Mailing Address: | 19728 Colima Rd Rowland Heights |
State: | CA US |
Postal Code: | 917483210 |
Phone Number: | 9095941758 |
Fax Number: | 9095944158 |
NPI Enumeration Date: | 05/21/2007 |
NPI Last Update Date: | 06/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |