Individual
ALONZO CARLOS BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1395 CENTER DR RM D1-19, GAINESVILLE, FL 32610-2803
(352) 273-6910
Mailing address
1395 CENTER DR RM D1-19, GAINESVILLE, FL 32610-0415
(352) 273-6910
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401414082
VA
1223P0700X
Prosthodontics
Primary
DN23627
FL
Other
Enumeration date
08/26/2013
Last updated
09/23/2020
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