Organization
DEREK R BLACKWELDER DMD PLLC
Active
Other names
Winnisquam Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK R BLACKWELDER DMD (DENTIST / OWNER)
(603) 528-1212
Entity
Organization
Contact information
Practice address
944 LACONIA ROAD, WINNISQUAM, NH 03289-1020
(603) 528-1212
(603) 528-1320
Mailing address
PO BOX 1020, 944 LACONIA ROAD, WINNISQUAM, NH 03289-1020
(603) 528-1212
(603) 528-1320
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30316266
—
NH
01
—
685235
UNITED CONCORDIA
NH
Enumeration date
06/10/2006
Last updated
01/09/2008
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