Organization
WACO KIDS DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON BLACKWELDER DDS (PRESIDENT)
(254) 772-8330
Entity
Organization
Contact information
Practice address
1121 LAKE AIR DR, WACO, TX 76710-4417
(254) 772-8330
Mailing address
1121 LAKE AIR DR, WACO, TX 76710-4417
(254) 772-8330
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22764
TX
Other
Enumeration date
11/02/2011
Last updated
11/02/2011
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