George Maury Blackburn, D.M.D., F.A.G.D.

Primary specialty

DentistTaxonomy code 122300000X

License

10496 Issued in TX

Practice address

12505 Hymeadow Dr
Suite 2D
Austin, TX 78750-1867

Phone

(512) 258-3627

Fax

(512) 258-0755

NPI assigned

Apr 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• George M. Blackburn Jr. D.M.D.

  • Dentist
  • Austin, TX
  • NPI 1083995500
  NPD (past) Authorized official
• Levo Dental 10 PLLC

  • General Practice Dentistry
  • Austin, TX
  • NPI 1699629741
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003870601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12505 HYMEADOW DR",
            "address_2": "SUITE 2D",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787501867",
            "telephone_number": "512-258-3627",
            "fax_number": "512-258-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12505 HYMEADOW DR",
            "address_2": "SUITE 2D",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787501867",
            "telephone_number": "512-258-3627",
            "fax_number": "512-258-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "GEORGE",
        "middle_name": "MAURY",
        "name_prefix": "Dr.",
        "credential": "D.M.D., F.A.G.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "10496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholette M Black, DO
• Patricia Black, LPC
• Blackburn Chiropractic PLLC
• Abigail Hollis Blackburn, DC
• Christian Blackburn
• Jon F Blackburn, OTR, CHT
• Olivia Ann Blacker, SLP-ASSISTANT
• Joanne M Blackerby, NBHWC - HWC
• Audrey Blackford, LMT
• Hayley Blackman, PT, DPT

• Dentist in Austin, TX
• Providers in Austin, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.