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Organization
GEORGE M. BLACKBURN JR. D.M.D.
Active
Organization
GEORGE M. BLACKBURN JR. D.M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE M. BLACKBURN D.M.D. (OWNER)
(512) 258-3627
Entity
Organization
Contact information
Practice address
12505 HYMEADOW DR, STE. 2 D, AUSTIN, TX 78750-1867
(512) 258-3627
Mailing address
12505 HYMEADOW DR, STE. 2 D, AUSTIN, TX 78750-1867
(512) 258-3627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003870601
INDIVIDUAL NPI
TX
Enumeration date
08/30/2011
Last updated
08/30/2011
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