Individual
JOSHUA DOLPHUS BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
919 CHAMBERS BLVD, STE A, BARDSTOWN, KY 40004-2573
(502) 348-6404
(502) 348-6342
Mailing address
919 CHAMBERS BLVD, STE A, BARDSTOWN, KY 40004-2573
(502) 348-6404
(502) 348-6342
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8415
KY
1223G0001X
General Practice Dentistry
Primary
8415
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100169660
—
KY
Enumeration date
08/30/2006
Last updated
10/10/2018
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