Kenneth Allen Blackmon Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4419CF Issued in AL

Practice address

815 S Brundidge St
Troy, AL 36081-3219

Phone

(334) 566-8266

Fax

(334) 566-7850

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

Yes

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

• Oak Park Dental LLC

  • General Practice Dentistry
  • Troy, AL
  • NPI 1134774219

  General Practice

  NPD Authorized official
• Oak Park Dental LLC

  • General Practice Dentistry
  • Enterprise, AL
  • NPI 1457052805

  General Practice

  NPD

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 13, 2023.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1215055041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360810248",
            "telephone_number": "334-566-8266",
            "fax_number": "334-566-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 S BRUNDIDGE ST",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360813219",
            "telephone_number": "334-566-8266",
            "fax_number": "334-566-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "KENNETH",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "4419CF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shemieka Berry, OT/L
• Alyssa Layne Billings
• Bio-Medical Applications of Alabama, Inc.
• Sydney Erin Bishop
• Jaycie Black
• Maggie Chandler Blagburn
• Danielle Blair
• Temekia Shauntrice Blakely
• Patricia A Block, M.D.
• John M Blough, D.O.

• All providers in Troy, AL
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.