NPIMap

Organization Active NPI

J Blake, DMD, PS

Doing business as KidSmile Dental

  • Pediatric Dentistry
  • Spokane Valley, WA
National Provider Identifier
1255531018
Registry record updated Mar 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
9846 Issued in WA
Legal business name
J BLAKE, DMD, PS
Doing business as
KidSmile Dental
Practice address
12615 E Mission Ave
Suite 312
Spokane Valley, WA 99216-1047
Phone
(509) 926-1234
Fax
(509) 926-1701
NPI assigned
Jul 20, 2007
Last updated
Mar 31, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2009

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

Authorized official

Name
Dr. T. Joel Blake, DMD
Title
Owner/Dentist
Phone
(509) 926-1234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 10588 WA
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 9846 WA Primary

Addresses

Primary practice location

12615 E Mission Ave
Suite 312
Spokane Valley, WA 99216-1047

Mailing address

12615 E Mission Ave
Suite 312
Spokane Valley, WA 99216-1047
Phone (509) 926-1234

Other names 1

  • KidSmile Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1255531018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12615 E MISSION AVE",
            "address_2": "SUITE 312",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161047",
            "telephone_number": "509-926-1234",
            "fax_number": "509-926-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12615 E MISSION AVE",
            "address_2": "SUITE 312",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161047",
            "telephone_number": "509-926-1234",
            "fax_number": "509-926-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J BLAKE, DMD, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "T. JOEL",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "509-926-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "10588",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "9846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KidSmile Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; 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.