Provider Demographics
NPI:1871606343
Name:BLACKFORD, ALLEN A (DDS)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:A
Last Name:BLACKFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 RIMROCK RD STE E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0700
Mailing Address - Country:US
Mailing Address - Phone:406-245-0303
Mailing Address - Fax:406-245-0303
Practice Address - Street 1:1690 RIMROCK RD STE E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0700
Practice Address - Country:US
Practice Address - Phone:406-245-0303
Practice Address - Fax:406-245-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT15884OtherBLUE CROSS BLUE SHIELD
MT12-7374Medicaid