Provider Demographics
NPI:1093156838
Name:BLACKER, CHRISTOPHER TALMAGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TALMAGE
Last Name:BLACKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16420 MERIDIAN E
Mailing Address - Street 2:#104
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2514
Mailing Address - Country:US
Mailing Address - Phone:253-445-6669
Mailing Address - Fax:253-840-4193
Practice Address - Street 1:16420 MERIDIAN E
Practice Address - Street 2:#104
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2514
Practice Address - Country:US
Practice Address - Phone:253-445-6669
Practice Address - Fax:253-840-4193
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60385528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist