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General NPI Number Information
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NPI Number | 1831631563
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Entity Type | Organization
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Legal Business Name | KAITLIN E. BLACKBURN DDS, PA
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Dates
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Enumeration Date | 11/11/2016
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 466 E NINE MILE RD
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City | PENSACOLA
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State | FL
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Zip | 32514-1441
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Country | US
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Telephone | 850-476-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 466 E NINE MILE RD
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City | PENSACOLA
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State | FL
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Zip | 32514-1441
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Country | US
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Telephone | 850-476-2552
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KAITLIN ELIZABETH BLACKBURN
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Credential | DDS
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Telephone | 812-306-4451
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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 | DN21161
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License Number State | FL
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