Blackmon, Keith A.

Blackmon, Keith A. is an individual health care provider with primary practice located at 107 Professional Ln , Dothan AL 36303-3875. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Blackmon, Keith A. can be contacted via phone (334) 792-5711.

Contact Information

Primary practice address
107 Professional Ln Dothan AL 36303-3875
Fax: (334) 678-8157
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 4491 Alabama

Profile Details

NPI number 1629017744
LBN Legal business name Blackmon, Keith A.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629017744 NPPES
Alabama Other 51502435 BCBS OF AL

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