Robert Jackson Blackburn Jr., DMD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

10383 Issued in NC

Practice address

4 Medical Park Dr
Asheville, NC 28803

Phone

(828) 255-7781

NPI assigned

Jul 28, 2016

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

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.

• DRS Farrell, Farrell, Nale, Cook, Kapitan, Mohamed, Franco, Wessel, Ho

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charlotte, NC
  • NPI 1972554186
  NPD (past)

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1013460872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEDICAL PARK DR",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "28803",
            "telephone_number": "828-255-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEDICAL PARK DR",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "28803",
            "telephone_number": "828-255-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "ROBERT",
        "middle_name": "JACKSON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-28",
        "last_updated": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NC",
            "license": "10383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iris Delia Black, RN
• Jason Allen Black, PA-C
• Martin L Black, M.D.
• Andrew James Blackburn, PAC
• Meredith June Blackburn, PHD
• Gabriella Catherine Blackmon, MSW/ PENDING LCSW-A
• Anna Renee Blackshear
• Shannon Leigh Brown Blackwood, OD
• Siara Leone Blackwood, RDMS, RVT
• Paige Annastasia Blaha, LCMHC-A, LCAS-A, ATR

• Prosthodontics in Asheville, NC
• Providers in Asheville, NC by specialty
• Prosthodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.