Smiles by Dr. Blackmon

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-020813 Issued in OH

Legal business name

SMILES BY DR. BLACKMON

Practice address

20119 Van Aken Blvd Ste 211
Shaker Heights, OH 44122-3636

Phone

(216) 848-1420

Fax

(216) 848-1400

NPI assigned

Feb 10, 2014

Last updated

Feb 10, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Denise Blackmon, D.D.S.

Title

Owner/Dentist

Phone

(216) 848-1420

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391990400000",
    "number": "1306260401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20119 VAN AKEN BLVD STE 211",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441223636",
            "telephone_number": "216-848-1420",
            "fax_number": "216-848-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20119 VAN AKEN BLVD STE 211",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441223636",
            "telephone_number": "216-848-1420",
            "fax_number": "216-848-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES BY DR. BLACKMON",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-10",
        "last_updated": "2014-02-10",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "216-848-1420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-020813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2066580",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Simpkins-Austin
• Alicia Marie Singer, LISW
• Marcella Lynn Slanker, QMHS
• Madison Slayton, LPC
• Rasheeda Smialek, SCHOOL PSYCHOLOGIST
• Kayla D Smiley
• Alisa Smith Williams
• Alayna Nicole Smith
• Bessie Lynn Smith, LPCC
• Chakira Smith, MPH

• General Practice Dentistry in Shaker Heights, OH
• Providers in Shaker Heights, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; 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.