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NPI Code Detail

MEDICARE: BLACKWOOD FAMILY DENTISTRY

MEDICARE: BLACKWOOD FAMILY DENTISTRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center60189KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103514OTHERKSDORAL LOCATION NUMBER
2116736OTHERKSBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1497839013
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACKWOOD FAMILY DENTISTRY
Provider Business Mailing Address
First Line : PO BOX 557
Second Line : 501 GARFIELD
City : QUINTER
State : KS
Zip : 67752-0557
Country : US
Telephone Number : 785-754-2441
Fax Number : 785-754-2466
Provider Business Practice Location Address
First Line : 501 GARFIELD ST
Second Line :
City : QUINTER
State : KS
Zip : 67752-9795
Country : US
Telephone Number : 785-754-2441
Fax Number : 785-754-2466
Authorized Official
Title or Position : DENTIST
Name : DR. ERIC BLACKWOOD
Credential : DDS
Telephone Number : 785-754-2441
Provider Enumeration Date : 10/24/2006
Last Update Date : 08/22/2020

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Directions to “BLACKWOOD FAMILY DENTISTRY ” Practice Location

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