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NPI Code Detail

MEDICARE: CAMRYN BLACKWELL

MEDICARE: CAMRYN BLACKWELL
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
1122300000XDentistD1528SD

General Provider Information

NPI Number : 1922930072
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMRYN BLACKWELL
Provider Business Mailing Address
First Line : 2626 STADHEIM DR
Second Line :
City : WATERTOWN
State : SD
Zip : 57201-7518
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20 19TH ST SE # 3938
Second Line :
City : WATERTOWN
State : SD
Zip : 57201-3938
Country : US
Telephone Number : 605-886-2805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ CAMRYN BLACKWELL ” Practice Location

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