Organization
SMILES BY DR. BLACKMON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA DENISE BLACKMON D.D.S. (OWNER/DENTIST)
(216) 848-1420
Entity
Organization
Contact information
Practice address
20119 VAN AKEN BLVD STE 211, SHAKER HEIGHTS, OH 44122-3636
(216) 848-1420
(216) 848-1400
Mailing address
20119 VAN AKEN BLVD STE 211, SHAKER HEIGHTS, OH 44122-3636
(216) 848-1420
(216) 848-1400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-020813
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2066580
—
OH
Enumeration date
02/10/2014
Last updated
02/10/2014
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