NPIMap

Organization Active NPI

Thomas J and Effie K Blue, DMD, PA

  • General Practice Dentistry
  • W Melbourne, FL
National Provider Identifier
1194124339
Registry record updated Aug 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN9554 Issued in FL
Legal business name
THOMAS J AND EFFIE K BLUE, DMD, PA
Practice address
575 S Wickham Rd
Suite D
W Melbourne, FL 32904-1170
Phone
(321) 768-0991
Fax
(321) 727-7909
NPI assigned
Aug 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2014

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

Authorized official

Name
Dr. Thomas J Blue, D.M.D.NPI 1518075530
Title
Owner/Dentist
Phone
(321) 768-0991

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN9554 FL Primary

Addresses

Primary practice location

575 S Wickham Rd
Suite D
W Melbourne, FL 32904-1170

Mailing address

575 S Wickham Rd
Suite D
W Melbourne, FL 32904-1170
Phone (321) 768-0991

National Provider Directory

National Provider Directory

Locations

575 S Wickham Rd
Ste D
West Melbourne, FL 32904
Phone (321) 768-0991

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1194124339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 S WICKHAM RD",
            "address_2": "SUITE D",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329041170",
            "telephone_number": "321-768-0991",
            "fax_number": "321-727-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 S WICKHAM RD",
            "address_2": "SUITE D",
            "city": "W MELBOURNE",
            "state": "FL",
            "postal_code": "329041170",
            "telephone_number": "321-768-0991",
            "fax_number": "321-727-7909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS J AND EFFIE K BLUE, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "BLUE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "321-768-0991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN9554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in W Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; 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.