Provider Demographics
NPI:1497839013
Name:BLACKWOOD FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BLACKWOOD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-754-2441
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:501 GARFIELD
Mailing Address - City:QUINTER
Mailing Address - State:KS
Mailing Address - Zip Code:67752-0557
Mailing Address - Country:US
Mailing Address - Phone:785-754-2441
Mailing Address - Fax:785-754-2466
Practice Address - Street 1:501 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:QUINTER
Practice Address - State:KS
Practice Address - Zip Code:67752-9795
Practice Address - Country:US
Practice Address - Phone:785-754-2441
Practice Address - Fax:785-754-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60189261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103514OtherDORAL LOCATION NUMBER
KS116736OtherBLUE CROSS BLUE SHIELD