Individual
CLAYTON BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2406 N BROAD ST, COLMAR, PA 18915-9701
(215) 712-8895
Mailing address
2406 N BROAD ST, COLMAR, PA 18915-9701
(215) 712-8895
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS044613
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS044613
PA
125Q00000X
Oral Medicine Dentistry
DS044613
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2024
Last updated
06/23/2026
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