Active NPI
Blake Taylor Ross, DMD
- General Practice Dentistry
- Evans, GA
National Provider Identifier
1225761828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN122726
- Practice address
- 655 N Belair Rd
Evans, GA 30809-4219 - Phone
- (706) 855-0052
- NPI assigned
- Jul 1, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN122726 | GA | Primary |
Addresses
Primary practice location
655 N Belair Rd
Evans, GA 30809-4219
Mailing address
1106 Azalea Dr
Augusta, GA 30904-3323
Phone (706) 373-4587
Other practice location 1
36 Cheatham St.
Wadley, GA 30477
Phone (478) 252-1184
Other practice location 2
4213 Columbia Rd
Martinez, GA 30907-1481
Phone (706) 868-6177
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 |
|---|---|---|---|
| DN122726 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunny Smiles LLC | General Practice | Current | Accepting new patients |
| Sunny Smiles LLC | Current | Accepting new patients | |
| Reed Creek Dental LLC | General Practice | Current | Accepting new patients |
Locations
655 N Belair Rd
Evans, GA 30809
Phone (706) 850-4040
4213 Columbia Rd
Martinez, GA 30907
Phone (706) 868-6177
Organizations & group practices 3
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656892800000",
"number": "1225761828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1106 AZALEA DR",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309043323",
"telephone_number": "706-373-4587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 N BELAIR RD",
"city": "EVANS",
"state": "GA",
"postal_code": "308094219",
"telephone_number": "706-855-0052"
}
],
"practiceLocations": [
{
"address_1": "36 Cheatham St.",
"address_purpose": "LOCATION",
"city": "Wadley",
"state": "GA",
"postal_code": "30477",
"country_code": "US",
"telephone_number": "478-252-1184",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4213 Columbia Rd",
"address_purpose": "LOCATION",
"city": "Martinez",
"state": "GA",
"postal_code": "309071481",
"country_code": "US",
"telephone_number": "706-868-6177",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROSS",
"first_name": "BLAKE",
"middle_name": "TAYLOR",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-01",
"last_updated": "2022-07-04",
"certification_date": "2022-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN122726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.