Provider Demographics
NPI:1265619886
Name:BLACKBURNE, TERRY D (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:D
Last Name:BLACKBURNE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 24TH AVE SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3987
Mailing Address - Country:US
Mailing Address - Phone:405-329-6106
Mailing Address - Fax:405-329-6107
Practice Address - Street 1:707 24TH AVE SW
Practice Address - Street 2:SUITE 202
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3987
Practice Address - Country:US
Practice Address - Phone:405-329-6106
Practice Address - Fax:405-329-6107
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics