Organization
W.R. BLACKWELDER D.D.S. , INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE R. BLACKWELDER D.D.S. (PRESIDENT)
(909) 594-1758
Entity
Organization
Contact information
Practice address
19728 COLIMA RD, ROWLAND HEIGHTS, CA 91748-3210
(909) 594-1758
(909) 594-4158
Mailing address
19728 COLIMA RD, ROWLAND HEIGHTS, CA 91748-3210
(909) 594-1758
(909) 594-4158
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2007
Last updated
06/13/2012
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