Blake Christopher Roberts, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2020021104 Issued in MO

Practice address

1112 Baxter St
Neosho, MO 64850-7814

Phone

(417) 451-2403

NPI assigned

Jul 14, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1295353480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 HALE MCGINTY DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648507814",
            "telephone_number": "417-434-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 BAXTER ST",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648507814",
            "telephone_number": "417-451-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "BLAKE",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2020021104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brice Reynolds
• Mallorie Ann Rhymer, M.D.
• Madison Rister, OTA
• Ashlea Nicole Ritter, PMHNP
• Robert L Sweeten MD Inc
• Nathan Allen Rodriguez, DO
• Rodd Rogers, D.C.
• Kayla M Rose
• Ashton Roush
• Rahab Rubia, OTR

• General Practice Dentistry in Neosho, MO
• Providers in Neosho, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; 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.