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General NPI Number Information
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NPI Number | 1891215760
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Entity Type | Individual
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Provider Name | RICHARD BLACKBURN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 3532 HOWARD AVE STE 200
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3699
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Country | US
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Telephone | 562-501-3188
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Fax |
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Provider Business Mailing Address
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Address Line | 3532 HOWARD AVE STE 200
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3699
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Country | US
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Telephone | 562-596-7484
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 104972
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License Number State | CA
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