Healthcare Provider Details

I. General information

NPI: 1487057303
Provider Name (Legal Business Name): ALBERTO SYLVESTER BLACKWOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 HEALTH PARK DR
MOORE HAVEN FL
33471-6206
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 863-946-0405
  • Fax: 863-946-0145
Mailing address:
  • Phone: 561-844-9443
  • Fax: 561-472-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN20720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: