Individual
RUSSELL SCOTT BLACKMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
16845 N 29TH AVE, SUITE 6, PHOENIX, AZ 85053-3053
(602) 866-0418
(602) 862-1194
Mailing address
16845 N 29TH AVE, SUITE 6, PHOENIX, AZ 85053-3053
(602) 866-0418
(602) 862-1194
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2325
AZ
Other
Enumeration date
01/23/2006
Last updated
07/08/2007
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