Active NPI
Shane Kyle Blacker, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Tempe, AZ
National Provider Identifier
1184892473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 6210
- Practice address
- 6200 S McClintock Dr Ste 11
Tempe, AZ 85283-3268 - Phone
- (480) 839-6262
- Fax
- (480) 839-1029
- NPI assigned
- Feb 20, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 6210 | AZ | Primary |
Addresses
Primary practice location
6200 S McClintock Dr Ste 11
Tempe, AZ 85283-3268
Mailing address
6200 S McClintock Dr Ste 11
Tempe, AZ 85283-3268
Phone (480) 839-6262
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6210 | AZ | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203465600000",
"number": "1184892473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6200 S MCCLINTOCK DR STE 11",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852833268",
"telephone_number": "480-839-6262",
"fax_number": "480-839-1029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 S MCCLINTOCK DR STE 11",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852833268",
"telephone_number": "480-839-6262",
"fax_number": "480-839-1029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKER",
"first_name": "SHANE",
"middle_name": "KYLE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-20",
"last_updated": "2008-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "AZ",
"license": "6210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.