Kristine Ep Blackwelder, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

03616 Issued in NH

Practice address

944 Laconia Road
Winnisquam, NH 03289

Phone

(603) 528-1212

Fax

(603) 528-1320

NPI assigned

Oct 6, 2005

Last updated

Nov 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arbor Dental Services

  • General Practice Dentistry
  • Gilford, NH
  • NPI 1922820703
  NPD Authorized official
• Derek R Blackwelder DMD PLLC

  dba Winnisquam Dental

  • General Practice Dentistry
  • Winnisquam, NH
  • NPI 1427099233
  NPD (past)

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1013905736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1020",
            "city": "WINNISQUAM",
            "state": "NH",
            "postal_code": "032891020",
            "telephone_number": "603-528-1212",
            "fax_number": "603-528-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "944 LACONIA ROAD",
            "city": "WINNISQUAM",
            "state": "NH",
            "postal_code": "03289",
            "telephone_number": "603-528-1212",
            "fax_number": "603-528-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELDER",
        "first_name": "KRISTINE",
        "middle_name": "EP",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-06",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NH",
            "license": "03616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3070636",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek Reade Blackwelder, DMD
• Derek R Blackwelder DMD PLLC (Winnisquam Dental)
• Jared Knighton, DMD
• Winnisquam Fire Department

• Dentist in Winnisquam, NH
• Providers in Winnisquam, NH by specialty
• Dentist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; 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.