James Edward Blood, D.M.D.
Individual provider Active NPI General Practice Dentistry · Dental Squadron, IN
NPI 1124013982 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1124013982
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019-20940 (IL)
- Practice address
- 375 Dental Squadron
310 W. Losey St.
Dental Squadron, IN 62225 - Phone
- (618) 256-2750
- NPI assigned
- Sep 16, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-20940 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-20940 | IL | Yes |
Addresses
Primary practice location
375 Dental Squadron
310 W. Losey St.
Dental Squadron, IN 62225
Mailing address
162 Knob Creek LN
O Fallon, IL 62269-6618
Phone (618) 632-1971
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.