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Individual

DR. JOHN S. BLALOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D

Contact information

Practice address
3606 WHEELER RD., AUGUSTA, GA 30909
(706) 481-8811
(706) 481-8507
Mailing address
3606 WHEELER RD., AUGUSTA, GA 30909
(706) 481-8811
(706) 481-8507

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
DN011681
GA
1223G0001X
General Practice Dentistry
Primary
DN011681
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000879095A
GA
05
ZG1681
SC
Enumeration date
05/25/2006
Last updated
10/26/2017
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