Blair Gregory Ota, DDS, MD

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

24159 Issued in CA

Practice address

4980 Barranca Pkwy Ste 190
Irvine, CA 92604-8652

Phone

(949) 453-9797

Fax

(949) 872-2468

NPI assigned

Nov 17, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1366516023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4980 BARRANCA PKWY STE 190",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926048652",
            "telephone_number": "949-453-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4980 BARRANCA PKWY STE 190",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926048652",
            "telephone_number": "949-453-9797",
            "fax_number": "949-872-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTA",
        "first_name": "BLAIR",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "CA",
            "license": "24159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oso Home Care, Inc.
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• Osp Health Management Inc
• Laura Ostrove
• Anna Ostrovsky, MFT
• Craig Kenji Ota, D.D.S
• Melissa Ota, DDS
• Tamer Adel Othman, M.D.
• Darrell G Otsu, DDS DENTIST
• Robert Leslie Otsu, DDS

• Oral and Maxillofacial Pathology Dentistry in Irvine, CA
• Providers in Irvine, CA by specialty
• Oral and Maxillofacial Pathology Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.