Burch Lee Blackstock, D.D.S

NPI #1144387234 in Lakeside, California

Provider Information

NPI Number: 1144387234
Entity Type: Individual
Name: Burch Lee Blackstock, D.D.S
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: D.D.S
Enumeration Date: Jan 2, 2007
Last Updated: Apr 17, 2014

Practice Location

Address: 12110 WOODSIDE AVE
City: Lakeside
State: California
ZIP Code: 92040-3012
Phone: (619) 443-0444

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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