| Derek R Blackwelder Dmd Pllc | |
|
944 Laconia Road Winnisquam NH 03289-1020 | |
| (603) 528-1212 | |
| (603) 528-1320 |
| Full Name | Derek R Blackwelder Dmd Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 944 Laconia Road, Winnisquam, New Hampshire |
| Authorized Official Name and Position | Derek R Blackwelder (DENTIST / OWNER) |
| Authorized Official Contact | 6035281212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derek R Blackwelder Dmd Pllc Po Box 1020 944 Laconia Road Winnisquam NH 03289-1020 Ph: (603) 528-1212 | Derek R Blackwelder Dmd Pllc 944 Laconia Road Winnisquam NH 03289-1020 Ph: (603) 528-1212 |
| NPI Number | 1427099233 |
|---|---|
| Provider Enumeration Date | 06/10/2006 |
| Last Update Date | 01/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427099233 | NPI | - | NPPES |
| 30316266 | Medicaid | NH | |
| 685235 | Other | NH | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (New Hampshire) | Primary |