Individual
TYLER BLACKENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8640 E STATE ROAD 70 # D, BRADENTON, FL 34202-3785
(941) 756-3410
Mailing address
8640 E STATE ROAD 70 # D, BRADENTON, FL 34202-3785
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN17591
FL
Other
Enumeration date
06/08/2009
Last updated
06/08/2009
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