Tyler Blackenburg

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN17591 Issued in FL

Practice address

8640 E State Road 70 # D
Bradenton, FL 34202-3785

Phone

(941) 756-3410

NPI assigned

Jun 8, 2009

Last updated

Jun 8, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Health Services Bradenton PA

  • Dentist
  • Bradenton, FL
  • NPI 1780716191
  NPD (past)

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1164658977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8640 E STATE ROAD 70 # D",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342023785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8640 E STATE ROAD 70 # D",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342023785",
            "telephone_number": "941-756-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKENBURG",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-08",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN17591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lorine Bishop, TSC/COTA
• Elizabeth Bissett, M.ED./ED.S., LMHC
• Ammalie Bittar
• Maryann Joyce Bivens, CPT
• Bja Incorporated (Comprehensive Sleep Disorder Center)
• Joan L Blackford-Heintz, DC
• Lisa Ann Blacklidge, PA-C
• Robert E Blackwood, MD
• Jaina Louise Blaine, CF-SLP
• Blake Imaging LLC (Blake Imaging)

• Periodontics in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; 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.