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1942495320 NPI number — DAVID PAUL BLACKBURN DMD, MSD

NPI Number: 1942495320
Health Care Provider/Practitioner: DAVID PAUL BLACKBURN DMD, MSD

Information about “1942495320” NPI (DAVID PAUL BLACKBURN DMD, MSD) exists in 1942495320 in HTML format HTML  |  1942495320 in plain Text format TXT  |  1942495320 in PDF (Portable Document Format) PDF  |  1942495320 in an XML format XML  formats.

NPI Number : 1942495320 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942495320",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLACKBURN",
    "FirstName": "DAVID",
    "MiddleName": "PAUL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD, MSD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3131 S. STATE ROUTE 291",
    "SecondLineMailingAddress": "SUITE A",
    "MailingAddressCityName": "INDEPENDENCE",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64057",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-373-6006",
    "MailingAddressFaxNumber": "816-373-1840",
    "FirstLinePracticeLocationAddress": "3131 S STATE ROUTE 291 STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDEPENDENCE",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "64057-2657",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-373-6006",
    "PracticeLocationAddressFaxNumber": "816-373-1840",
    "EnumerationDate": "09/10/2007",
    "LastUpdateDate": "02/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "2015012810",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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