Active NPI
Blane Reynolds Hamilton, D.M.D
- Pediatric Dentistry
- Mansfield, TX
National Provider Identifier
1285921825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 28654
- Practice address
- 1759 Broad Park Cir S
Ste 205
Mansfield, TX 76063-7833 - Phone
- (817) 453-2800
- NPI assigned
- Jul 4, 2011
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 28654 | TX | Primary |
Addresses
Primary practice location
1759 Broad Park Cir S
Ste 205
Mansfield, TX 76063-7833
Mailing address
2000 Highway 157 N Ste 120
Mansfield, TX 76063-4860
Phone (817) 466-8554
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 |
|---|---|---|---|
| 28654 | TX | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ikids Pediatric Dentistry Castle Hills, PLLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Lewisville, TX
- NPI 1487155826
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424217600000",
"number": "1285921825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 HIGHWAY 157 N STE 120",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760634860",
"telephone_number": "817-466-8554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1759 BROAD PARK CIR S",
"address_2": "STE 205",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760637833",
"telephone_number": "817-453-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAMILTON",
"first_name": "BLANE",
"middle_name": "REYNOLDS",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-04",
"last_updated": "2015-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "28654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.