Individual
BENJAMIN ROBERT BLACKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
718 YELM AVE W, YELM, WA 98597-8764
(360) 972-3330
Mailing address
718 YELM AVE W, YELM, WA 98597-8764
(360) 972-3330
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE61572599
WA
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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