Individual
DR. TY BLACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
605 RANDOLPH RD, FORT SILL, OK 73503-4535
(580) 442-5925
(580) 442-7147
Mailing address
1208 APPLE CREEK DR, ELGIN, OK 73538-8840
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN26345
FL
Other
Enumeration date
08/03/2021
Last updated
04/11/2023
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