Jonathan Blinstrub, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

63612 Issued in CA

Practice address

2240 E. Winrow Ave
US Army Dental Activity
Fort Huachuca, AZ 85613-7040

Phone

(520) 533-3144

NPI assigned

Aug 5, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1134538010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 E. WINROW AVE",
            "address_2": "US ARMY DENTAL ACTIVITY",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "856137040",
            "telephone_number": "520-533-3144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 E. WINROW AVE",
            "address_2": "US ARMY DENTAL ACTIVITY",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "856137040",
            "telephone_number": "520-533-3144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLINSTRUB",
        "first_name": "JONATHAN",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-05",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Fort Huachuca, AZ
• Providers in Fort Huachuca, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; 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.