NPIMap

Organization Active NPI

Evansville Endodontics

  • Endodontics
  • Evansville, IN
National Provider Identifier
1306948419
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
12010141A Issued in IN
Legal business name
EVANSVILLE ENDODONTICS
Practice address
1449 Kimber Lane
Ste 103a
Evansville, IN 47715
Phone
(812) 402-9600
NPI assigned
Sep 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James William Blackburn, DDSNPI 1417090903
Title
Dentist
Phone
(812) 402-9600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 12010139A IN
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 12010141A IN Primary

Addresses

Primary practice location

1449 Kimber Lane
Ste 103a
Evansville, IN 47715

Mailing address

1449 Kimber Lane
Ste 103a
Evansville, IN 47715
Phone (812) 402-9600

National Provider Directory

National Provider Directory
Tax ID family
Evansville Endodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1449 Kimber Ln
Ste 103A
Evansville, IN 47715
Phone (812) 401-5210

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306948419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1449 KIMBER LANE",
            "address_2": "STE 103A",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47715",
            "telephone_number": "812-402-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 KIMBER LANE",
            "address_2": "STE 103A",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47715",
            "telephone_number": "812-402-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSVILLE ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "812-402-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IN",
            "license": "12010139A",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IN",
            "license": "12010141A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.