Provider Demographics
NPI:1477945400
Name:BLACKBURN, NATHON ALLAN (DMD)
Entity Type:Individual
Prefix:
First Name:NATHON
Middle Name:ALLAN
Last Name:BLACKBURN
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:PO BOX 35151
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5151
Mailing Address - Country:US
Mailing Address - Phone:907-317-6070
Mailing Address - Fax:817-977-4688
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:FIREWEED DENTAL
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-2000
Practice Address - Fax:907-729-5178
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist