Active NPI
Paul J Blaha, DDS MS
- Periodontics
- Sycamore, IL
National Provider Identifier
1124134283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- Practice address
- 1976 Aberdeen Court
Suite a
Sycamore, IL 60178 - Phone
- (815) 758-3457
- Fax
- (815) 758-0274
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | ID | Primary |
Addresses
Primary practice location
1976 Aberdeen Court
Suite a
Sycamore, IL 60178
Mailing address
1976 Aberdeen Court
Suite a
Sycamore, IL 60178
Phone (815) 758-3457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019023816 | ID | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124134283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1976 ABERDEEN COURT",
"address_2": "SUITE A",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "60178",
"telephone_number": "815-758-3457",
"fax_number": "815-758-0274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1976 ABERDEEN COURT",
"address_2": "SUITE A",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "60178",
"telephone_number": "815-758-3457",
"fax_number": "815-758-0274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAHA",
"first_name": "PAUL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "ID",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sycamore, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.