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General NPI Number Information
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NPI Number | 1174804058
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Entity Type | Organization
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Legal Business Name | HALEIGH S. BLACKWELL, DMD, PC
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 3145 GREEN VALLEY RD SUITE 101
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City | VESTAVIA
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State | AL
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Zip | 35243-5256
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Country | US
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Telephone | 205-970-7292
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Fax | 205-623-3036
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Provider Business Mailing Address
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Address Line | 3145 GREEN VALLEY RD SUITE 101
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City | VESTAVIA
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State | AL
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Zip | 35243-5256
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Country | US
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Telephone | 205-970-7292
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Fax | 205-623-3036
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HALEIGH STIDHAM BLACKWELL
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Credential | D.M.D.
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Telephone | 205-970-7292
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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 | 5852
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License Number State | AL
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