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General NPI Number Information
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NPI Number | 1013905736
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Entity Type | Individual
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Provider Name | KRISTINE EP BLACKWELDER DMD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 944 LACONIA ROAD
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City | WINNISQUAM
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State | NH
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Zip | 03289
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Country | US
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Telephone | 603-528-1212
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Fax | 603-528-1320
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Provider Business Mailing Address
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Address Line | PO BOX 1020
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City | WINNISQUAM
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State | NH
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Zip | 03289-1020
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Country | US
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Telephone | 603-528-1212
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Fax | 603-528-1320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 03616
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License Number State | NH
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