Provider Demographics
NPI:1851353205
Name:BLACKBURN, DENNIS CHRISTIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CHRISTIAN
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 MEINECKE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1721
Mailing Address - Country:US
Mailing Address - Phone:805-349-9545
Mailing Address - Fax:805-349-8025
Practice Address - Street 1:2342 PROFESSIONAL PKWY
Practice Address - Street 2:200
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1630
Practice Address - Country:US
Practice Address - Phone:805-349-9545
Practice Address - Fax:805-349-8025
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7267207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AZ727670Medicaid
CA00AZ727670Medicaid
CAG05052Medicare UPIN