Lisa Denise Blackmon, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

20813 Issued in OH

Practice address

3729 Lee Road
Shaker Heights Dental Express
Shaker Heights, OH 44120

Phone

(216) 751-9922

Fax

(216) 752-0870

NPI assigned

Nov 28, 2006

Last updated

Oct 26, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Professional Dental Alliance

  • General Practice Dentistry
  • Shaker Heights, OH
  • NPI 1891090064
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256515200000",
    "number": "1235205527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3729 LEE ROAD",
            "address_2": "SHAKER HEIGHTS DENTAL EXPRESS",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "44120",
            "telephone_number": "216-751-9922",
            "fax_number": "216-752-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3729 LEE ROAD",
            "address_2": "SHAKER HEIGHTS DENTAL EXPRESS",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "44120",
            "telephone_number": "216-751-9922",
            "fax_number": "216-752-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "LISA",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2009-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "20813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2066580",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frederic Carl Bishko, M.D.
• Corrie E Bissell, LSW
• Ashley Krystyna Bjelicic, PA
• Alison Ann Black, LSW
• Tulani Black
• Jacqueline Blackwell
• Blessing Hearts Home Healthcare Inc
• Carolyn Ann Blumenthal, LSW
• Sharon A Bobik
• Marissa Bodell

• Dentist in Shaker Heights, OH
• Providers in Shaker Heights, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; 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.