Individual
ANDREW NICHOLAS BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
387 MAIN ST S, WOODBURY, CT 06798-3412
(203) 263-5300
Mailing address
100 PLEASANT DR, SOUTHBURY, CT 06488-3231
(973) 627-0896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11-610
CT
Other
Enumeration date
04/02/2015
Last updated
12/03/2020
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