Individual
SHANE KYLE BLACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6200 S MCCLINTOCK DR STE 11, TEMPE, AZ 85283-3268
(480) 839-6262
(480) 839-1029
Mailing address
6200 S MCCLINTOCK DR STE 11, TEMPE, AZ 85283-3268
(480) 839-6262
(480) 839-1029
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6210
AZ
Other
Enumeration date
02/20/2008
Last updated
02/20/2008
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