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General NPI Number Information
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NPI Number | 1497363402
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Entity Type | Individual
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Provider Name | RILEY DAVIS BLACKHURST DDS
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Gender | Male
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 935 SW HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59803-1460
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Country | US
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Telephone | 406-721-2686
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 RATTLESNAKE DR
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City | MISSOULA
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State | MT
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Zip | 59802-3019
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Country | US
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Telephone | 208-697-2794
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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 | DEN-DEN-LIC-19340
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License Number State | MT
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