Individual
DR. LACEY TODD BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5954 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 739-1600
Mailing address
6206 DUSTIN DR, RICHMOND, VA 23226-2510
(540) 793-5965
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417212
VA
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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