Active NPI
Rosa C Blanco, D.M.D.
- Pediatric Dentistry
- Evans, GA
National Provider Identifier
1326194580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 10760
- Practice address
- 4369 Evans to Locks Rd
Evans, GA 30809-4099 - Phone
- (706) 863-8198
- NPI assigned
- Jan 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 10760 | GA | Primary |
Addresses
Primary practice location
4369 Evans to Locks Rd
Evans, GA 30809-4099
Mailing address
4369 Evans to Locks Rd
Evans, GA 30809-4099
Phone (706) 863-8198
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 |
|---|---|---|---|
| 10760 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316390400000",
"number": "1326194580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4369 EVANS TO LOCKS RD",
"city": "EVANS",
"state": "GA",
"postal_code": "308094099",
"telephone_number": "706-863-8198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4369 EVANS TO LOCKS RD",
"city": "EVANS",
"state": "GA",
"postal_code": "308094099",
"telephone_number": "706-863-8198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO",
"first_name": "ROSA",
"middle_name": "C",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-28",
"last_updated": "2011-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "10760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.