Blackstad, Dennis Sidney

Blackstad, Dennis Sidney is an individual health care provider with primary practice located at 730 E Taft Ave , Sapulpa OK 74066-5766. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Blackstad, Dennis Sidney can be contacted via phone (918) 216-4006.

Contact Information

Primary practice address
730 E Taft Ave Sapulpa OK 74066-5766
Phone: (918) 216-4006
Fax: (918) 216-4007
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 3650 Oklahoma
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 3650 Oklahoma

Profile Details

NPI number 1710040894
LBN Legal business name Blackstad, Dennis Sidney
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2006
Last updated Jan 20th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710040894 NPPES
Oklahoma MEDICAID 100171140A

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