Individual
DENNIS SIDNEY BLACKSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
511 N ASPEN AVE, BROKEN ARROW, OK 74012-2220
(918) 806-8050
(918) 995-3773
Mailing address
PO BOX 342, BROKEN ARROW, OK 74013-0342
(918) 806-8050
(918) 995-3773
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
3650
OK
207Q00000X
Family Medicine Physician
Primary
3650
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100171140A
—
OK
Enumeration date
12/19/2006
Last updated
04/23/2026
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