| Smiles By Dr. Blackmon | |
|
20119 Van Aken Blvd Ste 211 Shaker Heights OH 44122-3636 | |
| (216) 848-1420 | |
| (216) 848-1400 |
| Full Name | Smiles By Dr. Blackmon |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 20119 Van Aken Blvd Ste 211, Shaker Heights, Ohio |
| Authorized Official Name and Position | Lisa Denise Blackmon (OWNER/DENTIST) |
| Authorized Official Contact | 2168481420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smiles By Dr. Blackmon 20119 Van Aken Blvd Ste 211 Shaker Heights OH 44122-3636 Ph: (216) 848-1420 | Smiles By Dr. Blackmon 20119 Van Aken Blvd Ste 211 Shaker Heights OH 44122-3636 Ph: (216) 848-1420 |
| NPI Number | 1306260401 |
|---|---|
| Provider Enumeration Date | 02/10/2014 |
| Last Update Date | 02/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306260401 | NPI | - | NPPES |
| 2066580 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30-020813 (Ohio) | Primary |
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