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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