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ANDREW NICHOLAS BLACKWELL D.M.D.
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1801281241
Individual Registrant: ANDREW NICHOLAS BLACKWELL D.M.D.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
387 MAIN ST S WOODBURY, CT 06798-3412 US
Tel: 203-263-5300 Fax: --
Tel: 203-263-5300 Fax: --
Contact information for business:
100 PLEASANT DR SOUTHBURY, CT 06488-3231 US
Tel: 973-627-0896 Fax: --
Tel: 973-627-0896 Fax: --
Registration Information:
NPI: 1801281241
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | CT | 11-610 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
