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General NPI Number Information
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NPI Number | 1164639100
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Entity Type | Organization
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Legal Business Name | BLACKWELL DENTISTRY LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 S DOBSON RD STE C25
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City | CHANDLER
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State | AZ
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Zip | 85224-5690
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Country | US
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Telephone | 480-726-8464
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Fax | 480-726-8465
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Provider Business Mailing Address
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Address Line | 600 S DOBSON RD STE C25
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City | CHANDLER
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State | AZ
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Zip | 85224-5690
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Country | US
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Telephone | 480-726-8464
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Fax | 480-726-8465
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. CHAD R BLACKWELL
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Credential | DMD
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Telephone | 480-726-8464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5291
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License Number State | AZ
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