| Richard Blackburn Dmd, Inc | |
|
3532 Howard Ave Ste 200 Los Alamitos CA 90720-3699 | |
| (562) 596-7484 | |
| Not Available |
| Full Name | Richard Blackburn Dmd, Inc |
|---|---|
| Speciality | Dentist |
| Location | 3532 Howard Ave Ste 200, Los Alamitos, California |
| Authorized Official Name and Position | Richard Blackburn (OWNER) |
| Authorized Official Contact | 5625967484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Blackburn Dmd, Inc 3532 Howard Ave Ste 200 Los Alamitos CA 90720-3699 Ph: () - | Richard Blackburn Dmd, Inc 3532 Howard Ave Ste 200 Los Alamitos CA 90720-3699 Ph: (562) 596-7484 |
| NPI Number | 1457023921 |
|---|---|
| Provider Enumeration Date | 10/01/2021 |
| Last Update Date | 12/03/2021 |
| Medicare PECOS PAC ID | 1557752508 |
|---|---|
| Medicare Enrollment ID | O20211229001660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457023921 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Richard Blackburn |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1891215760 PECOS PAC ID: 2466843412 Enrollment ID: I20211229001706 |
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