Individual
DR. DEREK READE BLACKWELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
944 LACONIA ROAD, WINNISQUAM, NH 03289
(603) 528-1212
(603) 528-1320
Mailing address
PO BOX 1020, WINNISQUAM, NH 03289-1020
(603) 528-1212
(603) 528-1320
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
03600
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24636371
—
NM
05
—
3070586
—
NH
05
—
945719
—
AZ
Enumeration date
09/30/2005
Last updated
04/05/2016
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