Individual
DR. BRUCE A. BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
200 S DIXON RD, KOKOMO, IN 46901-5073
(765) 456-3015
(765) 456-1825
Mailing address
200 S DIXON RD, KOKOMO, IN 46901-5073
(765) 456-3015
(765) 456-1825
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007761A
IN
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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