Individual
DAVID S BLACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
615 W. WALDRIP ST., ELMA, WA 98541
(360) 482-4000
(360) 482-8427
Mailing address
PO BOX D1, ELMA, WA 98541-0600
(360) 482-4000
(360) 482-8427
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00009588
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5043393
—
WA
Enumeration date
11/03/2006
Last updated
07/08/2007
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