Individual provider · NPI-1

Dr. Riley Davis Blackhurst, DDS

Dentist, General Practice · Missoula, MT

NPI number1497363402
StatusActive
Last updated in NPPESJul 15, 2020

Details

NPI
1497363402
Entity type
Individual (NPI-1)
Name
Dr. Riley Davis Blackhurst
Credential
DDS
Sex
Male
Sole proprietor
No
Enumeration date
Jul 15, 2020
Certification date
Jul 15, 2020
Last updated
Jul 15, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeDEN-DEN-LIC-19340MTYes

Practice location

935 Sw Higgins Ave
Missoula, MT 59803-1460

Phone 406-721-2686

Mailing address

4620 Rattlesnake Dr
Missoula, MT 59802-3019

Phone 208-697-2794

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Dentist, General Practice providers in Missoula, MT