Provider Demographics
NPI:1629296553
Name:BLACKWELDER, AARON CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:CHRISTIAN
Last Name:BLACKWELDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 LAKE AIR DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4417
Mailing Address - Country:US
Mailing Address - Phone:254-772-8330
Mailing Address - Fax:254-772-8496
Practice Address - Street 1:1121 LAKE AIR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4417
Practice Address - Country:US
Practice Address - Phone:254-772-8330
Practice Address - Fax:254-772-8496
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084361223P0221X
TX227641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry