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General NPI Number Information
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NPI Number | 1184297574
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Entity Type | Individual
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Provider Name | AKIA D BLACKMON DMD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 1384 ATWOOD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-4904
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Country | US
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Telephone | 401-934-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 HARTWELL RD
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City | LOCUST GROVE
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State | GA
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Zip | 30248-4589
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Country | US
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Telephone | 229-347-4565
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN03572
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License Number State | RI
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