Greater Owensboro Pediatric Dentistry, Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

GREATER OWENSBORO PEDIATRIC DENTISTRY, INC

Practice address

3817 Fairview Dr
Owensboro, KY 42303-2117

Phone

(270) 683-7114

NPI assigned

Dec 9, 2021

Organization subpart

No

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

Authorized official

Name

Blake Dickens, DMDNPI 1154852697

Title

President

Phone

(270) 683-7114

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Blake Allen Dickens, D.M.D.

  • Pediatric Dentistry
  • Owensboro, KY
  • NPI 1154852697
  NPD Authorized official

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1013676758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3817 FAIRVIEW DR",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423032117",
            "telephone_number": "270-683-7114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3817 FAIRVIEW DR",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423032117",
            "telephone_number": "270-683-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER OWENSBORO PEDIATRIC DENTISTRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-683-7114",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David S Graham, MD
• Lisa Faye Graham, RPH
• Kelly Gray
• Natalie Gray, PT, DPT
• Greater Owensboro Counseling Partners Inc
• Green River Area Development District
• Green River District Health Department
• Green River District Health Department
• Green River District Health Department
• Green River District Health Department

• Pediatric Dentistry in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.