Blackstockdentalcorp

Blackstockdentalcorp is a healthcare organization registered as General Practice Dentistry in Lakeside, CA, holding Type 2 (organization) NPI 1417168881 since 2007. The authorized official on file is Burch Blackstock, Dentist.

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NPI	1417168881
Entity type	Organization (Type 2)
Legal business name	Blackstockdentalcorp
Practice address	12110 WOODSIDE AVE, Lakeside, CA, 92040
Phone	6194430444
Fax	6194430050
Enumeration date	2007-05-25
Last updated in NPPES	2016-02-10

Authorized official

Name	Burch Blackstock
Title	Dentist
Phone	6194430444

Taxonomy & classification

Taxonomy code	Specialty	Primary	License	State
1223G0001X	General Practice Dentistry	Primary	42123	CA

Other identifiers

Identifier	Type	State	Issuer
42123	Other	CA	DENTAL BOARD

Copy-ready billing details

Provider: Blackstockdentalcorp
NPI: 1417168881
Taxonomy: 1223G0001X (General Practice Dentistry)
Address: 12110 WOODSIDE AVE, Lakeside, CA, 92040

Providers at this address

NPI	Name	Type	Specialty	Location
1144387234	Burch Blackstock	Individual	General Practice Dentistry	Lakeside, CA
1770940637	Arthur Santos DDS Corp	Organization	Dental Clinic/Center	Lakeside, CA
1659730182	Ivan Santos	Individual	Dentist	Lakeside, CA
1194419390	Cesar Ayala	Individual	General Practice Dentistry	Lakeside, CA

Verify this record

Cross-check NPI 1417168881 against the authoritative CMS record: view Blackstockdentalcorp on the official NPPES registry .

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.

Frequently asked questions

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2016-02-10. Verify at npiregistry.cms.hhs.gov.

Where is Blackstockdentalcorp located?

The practice location on file with NPPES is in Lakeside, CA.

Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2016-02-10.