Leland S Blough Jr DMD LTD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2455 Issued in RI

Legal business name

LELAND S BLOUGH JR DMD LTD

Practice address

33 College Hill Rd
Suite 5a
Warwick, RI 02886-2776

Phone

(401) 828-3688

Fax

(401) 828-8588

NPI assigned

Mar 13, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Leland S Blough Jr., DMD

Title

President

Phone

(401) 828-3688

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1073888798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 COLLEGE HILL RD",
            "address_2": "SUITE 5A",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862776",
            "telephone_number": "401-828-3688",
            "fax_number": "401-828-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 COLLEGE HILL RD",
            "address_2": "SUITE 5A",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862776",
            "telephone_number": "401-828-3688",
            "fax_number": "401-828-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LELAND S BLOUGH JR DMD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "BLOUGH",
        "authorized_official_first_name": "LELAND",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-828-3688",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "RI",
            "license": "2455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "198008128",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Warwick, RI
• Providers in Warwick, RI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.