Jon Jarrod Blackledge, D.M.D
Individual provider Active NPI General Practice Dentistry · Springfield, PA
NPI 1194920264 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194920264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS037220 (PA)
- Practice address
- 1 W Woodland Ave
Springfield, PA 19064-2325 - Phone
- (610) 543-5673
- Fax
- (610) 543-0299
- NPI assigned
- Jun 19, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS037220 | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Dental Associates, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS037220 | PA | Yes |
Addresses
Primary practice location
1 W Woodland Ave
Springfield, PA 19064-2325
Mailing address
1 W Woodland Ave
Springfield, PA 19064-2325
Phone (610) 543-5673
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All providers in Springfield, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.