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General NPI Number Information
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NPI Number | 1508234030
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Entity Type | Organization
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Legal Business Name | NEIL BLACKBURN DDS, INC.
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 93 E MAIN ST
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City | AMELIA
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State | OH
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Zip | 45102-1948
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Country | US
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Telephone | 513-753-7199
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Fax | 513-753-8843
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Provider Business Mailing Address
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Address Line | 93 E MAIN ST
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City | AMELIA
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State | OH
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Zip | 45102-1948
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Country | US
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Telephone | 513-753-7199
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Fax | 513-753-8843
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHERYL BLACKBURN
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Credential |
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Telephone | 513-753-7199
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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 | 30015396
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License Number State | OH
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