Provider Demographics
NPI:1164639100
Name:BLACKWELL DENTISTRY LLC
Entity Type:Organization
Organization Name:BLACKWELL DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-726-8464
Mailing Address - Street 1:600 S DOBSON RD STE C25
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5690
Mailing Address - Country:US
Mailing Address - Phone:480-726-8464
Mailing Address - Fax:480-726-8465
Practice Address - Street 1:600 S DOBSON RD STE C25
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5690
Practice Address - Country:US
Practice Address - Phone:480-726-8464
Practice Address - Fax:480-726-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5291261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental