Individual
MACKENZIE JEAN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
604 N. THOMAS ST, SOUTH HILL, VA 23970
(434) 447-4464
Mailing address
P.O. BOX 599, 604 N. THOMAS ST, SOUTH HILL, VA 23970
(434) 447-4464
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0402207558
VA
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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