Dr. Jacob Steven Blackhurst, DDS
Dentist in Apo, AA. Individual provider (NPI-1).
NPI number1154938520
StatusActive
Last updated in NPPESMar 20, 2023
Details
- NPI
- 1154938520
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jacob Steven Blackhurst
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 29, 2020
- Certification date
- Mar 20, 2023
- Last updated
- Mar 20, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 11821131-992 | UT | Yes |
Practice location
Bldg 4-1838 Normandy DrApo, AA 28307-7302
Phone 910-432-6190
Mailing address
735 Exeter StCarthage, NC 28327-1455
Phone 801-669-1992
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