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Blackstockdentalcorp
General Practice Dentistry in Lakeside, California
NPI 1417168881

Blackstockdentalcorp is a General Practice Dentistry based in Lakeside, CA and is specialized in General Practice. Blackstockdentalcorp practices in Lakeside, CA. The NPI Number for Blackstockdentalcorp is 1417168881 and holds a License No. 42123 (California).

The current practice location address for Blackstockdentalcorp is 12110 Woodside Ave, Lakeside, CA and can be reached out via phone at 619-443-0444 and via fax at 619-443-0050.

Location: 12110 Woodside Ave, Lakeside, CA, 92040-3012
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1417168881
Provider Name
Blackstockdentalcorp
Credential
Provider Entity Type
Organization
Address
12110 Woodside Ave, Lakeside, CA, 92040-3012
Phone Number
619-443-0444
Fax Number
619-443-0050
Provider Enumeration Date
05/25/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
42123 01 CA DENTAL BOARD
institution
Provider Business Practice Location Address Details
Address
12110 Woodside Ave
City
Lakeside
State
California
Zip
92040-3012
Phone Number
619-443-0444
Fax Number
619-443-0050
person
Provider Business Mailing Address Details
Address
12110 Woodside Ave
City
Lakeside
State
California
Zip
92040-3012
Phone Number
619-443-0444
Fax Number
619-443-0050
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
42123 (California)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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