Individual
AMANDA MARIE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2124 E BOULEVARD, KOKOMO, IN 46902-2401
(765) 454-9700
(765) 454-9771
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(866) 803-4943
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011504A
IN
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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