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NPI Code Detail

MEDICARE: DOUGLAS G BLACKMORE

MEDICARE: DOUGLAS G BLACKMORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDI 015264NJ

General Provider Information

NPI Number : 1841416229
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOUGLAS G BLACKMORE
Provider Business Mailing Address
First Line : 1 PLAZA LN
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1829
Country : US
Telephone Number : 201-934-7707
Fax Number : 201-934-1954
Provider Business Practice Location Address
First Line : 1 PLAZA LN
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1829
Country : US
Telephone Number : 201-934-7707
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DOUGLAS G BLACKMORE
Credential : DDS
Telephone Number : 201-934-7707
Provider Enumeration Date : 04/17/2007
Last Update Date : 02/15/2011

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