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General NPI Number Information
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NPI Number | 1942495320
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Entity Type | Individual
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Provider Name | DAVID PAUL BLACKBURN DMD, MSD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 3131 S STATE ROUTE 291 STE A
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2657
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Country | US
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Telephone | 816-373-6006
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Fax | 816-373-1840
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Provider Business Mailing Address
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Address Line | 3131 S. STATE ROUTE 291 SUITE A
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City | INDEPENDENCE
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State | MO
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Zip | 64057
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Country | US
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Telephone | 816-373-6006
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Fax | 816-373-1840
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2015012810
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License Number State | MO
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