Blackrock Dental Partners, PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

D4330 Issued in ID

Legal business name

BLACKROCK DENTAL PARTNERS, PLLC

Doing business as

Blackrock Dental

Practice address

1606 E. Center St.
Pocatello, ID 83201-4007

Phone

(208) 232-5294

Fax

(208) 233-5188

NPI assigned

Nov 24, 2010

Organization subpart

No

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

Authorized official

Name

Joshua R. Gibbons, DDS

Title

Owner

Phone

(208) 232-5294

Specialties & licenses 1

Addresses

Other names 1

• Blackrock Dental Doing business as

Practitioners 1

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

• Jonathan Ray Elmer, DDS

  • Dentist
  • Bountiful, UT
  • NPI 1730192980
  NPD (past)

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

{
    "created_epoch": "1290556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574812800000",
    "number": "1356643308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 E. CENTER ST.",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014007",
            "telephone_number": "208-232-5294",
            "fax_number": "208-233-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 E. CENTER ST.",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014007",
            "telephone_number": "208-232-5294",
            "fax_number": "208-233-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKROCK DENTAL PARTNERS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-24",
        "last_updated": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-232-5294",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackrock Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randy Lyman Bishop, M.S.
• Christine E Black, MD
• Robert Grant Black, PT
• Melanie Blackburn
• Blackrock Counseling
• Carol Blackwell, PHARMD
• Gustin Ross Blad, FNP-BC
• James L Blaine, P.A.-C
• Benjamin Blair, MD
• Blake D. Alexander, MD, PA

• Dentist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; 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.