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Organization
WD DENTAL
Active
Organization
WD DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BURCH LEE BLACKSTOCK D.D.S. (DENTIST)
(619) 409-1444
Entity
Organization
Contact information
Practice address
855 THIRD AVE.SUITE#2230, CHULA VISTA, CA 91910-1350
(619) 409-1444
(619) 409-1496
Mailing address
855 THIRD AVE.SUITE#2230, CHULA VISTA, CA 91910-1350
(619) 409-1444
(619) 409-1496
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
42123
CA
Other
Enumeration date
05/25/2007
Last updated
08/22/2020
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