Individual
MRS. MARILYN BLACKMUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PDHAP
Contact information
Practice address
2209 SAN GORGONIO RD, LA CANADA, CA 91011-1352
(818) 957-1589
(818) 957-1589
Mailing address
2209 SAN GORGONIO RD, LA CANADA, CA 91011-1352
(818) 957-1589
(818) 957-1589
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
HAP11
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133068
DELTA DENTAL INS
CA
05
—
28993701
—
CA
Enumeration date
04/13/2007
Last updated
07/08/2007
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