Raquel Blanco, DMD – Dentist in Gainesville, FL

Key facts

NPI: 1073962965
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: DN21880 (FL)
Practice address: 5622 NW 43Rd St
Gainesville, FL 32653-3332
Phone: (352) 378-3139
Fax: (352) 371-0135
NPI assigned: Jun 10, 2016
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Comfortable Care Dental Health Professionals, PA General Practice Dentistry · Gainesville, FL · NPI 1326240201

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20161012000240	FL	Order and Referring Only - Dentist Practitioner - Dentist	2264720002

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Comfortable Care Dental Health Professionals, PA		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	DN21880	FL	Yes

Addresses

Primary practice location

5622 NW 43Rd St
Gainesville, FL 32653-3332

Mailing address

5622 NW 43Rd St
Gainesville, FL 32653-3332
Phone (352) 378-3139

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 10, 2016.

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1073962965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5622 NW 43RD ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326533332",
            "telephone_number": "352-378-3139",
            "fax_number": "352-371-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5622 NW 43RD ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326533332",
            "telephone_number": "352-378-3139",
            "fax_number": "352-371-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCO",
        "first_name": "RAQUEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-10",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN21880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

All providers in Gainesville, FL · Dentist in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.