Provider Demographics
NPI:1013905736
Name:BLACKWELDER, KRISTINE EP (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:EP
Last Name:BLACKWELDER
Suffix:
Gender:F
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 1020
Mailing Address - Street 2:
Mailing Address - City:WINNISQUAM
Mailing Address - State:NH
Mailing Address - Zip Code:03289-1020
Mailing Address - Country:US
Mailing Address - Phone:603-528-1212
Mailing Address - Fax:603-528-1320
Practice Address - Street 1:944 LACONIA ROAD
Practice Address - Street 2:
Practice Address - City:WINNISQUAM
Practice Address - State:NH
Practice Address - Zip Code:03289
Practice Address - Country:US
Practice Address - Phone:603-528-1212
Practice Address - Fax:603-528-1320
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3070636Medicaid