Provider Demographics
NPI:1790881662
Name:BLACKMAN, SCOTT G (DDS MS ORTHODONTICS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:DDS MS ORTHODONTICS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2301 RUDOLPHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2228
Mailing Address - Country:US
Mailing Address - Phone:931-647-6370
Mailing Address - Fax:931-647-7975
Practice Address - Street 1:2301 RUDOLPHTOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2228
Practice Address - Country:US
Practice Address - Phone:931-647-6370
Practice Address - Fax:931-647-7975
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS70411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics