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General NPI Number Information
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NPI Number | 1073327995
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Entity Type | Organization
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Legal Business Name | BBCCS PLLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 2145 WOODLANE DR STE 104
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City | WOODBURY
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State | MN
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Zip | 55125-1920
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Country | US
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Telephone | 651-738-8204
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Fax |
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Provider Business Mailing Address
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Address Line | 11077 SWEETWATER PATH
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City | SAINT PAUL
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State | MN
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Zip | 55129-5292
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Country | US
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Telephone | 406-698-0293
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRIAN EUGENE BLACKWELL
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Credential | DDS
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Telephone | 406-698-0293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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