| NPI | 1417168923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BURCH LEE BLACKSTOCK Dentist 619-409-1444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 42123) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |