Provider Demographics
NPI:1093896623
Name:BLACKMORE, RODNEY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:MARK
Last Name:BLACKMORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1376 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5566
Mailing Address - Country:US
Mailing Address - Phone:972-869-4683
Mailing Address - Fax:972-869-4226
Practice Address - Street 1:9901 VALLEY RANCH PKWY E STE 1001
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7175
Practice Address - Country:US
Practice Address - Phone:972-869-4683
Practice Address - Fax:972-869-4226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX199381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice