David S Blackett, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00009588 Issued in WA

Practice address

615 W. Waldrip St.
Elma, WA 98541

Phone

(360) 482-4000

Fax

(360) 482-8427

NPI assigned

Nov 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366521817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX D1",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "985410600",
            "telephone_number": "360-482-4000",
            "fax_number": "360-482-8427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W. WALDRIP ST.",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "98541",
            "telephone_number": "360-482-4000",
            "fax_number": "360-482-8427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKETT",
        "first_name": "DAVID",
        "middle_name": "S",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5043393",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amir Atabeygi, MD
• Maja C Ballew, L.M.P.
• Behavioral Health Resources
• Sierra Berry, PA-C
• Mary Ellen Biggerstaff, ARNP
• Rebecca Jane Blumberg, LMP
• Sarah Anna Bradford, NP-C
• Laura Brownsmith, ARNP
• Donna Jean Burkhart, SWAA
• Michele Burtner

• General Practice Dentistry in Elma, WA
• Providers in Elma, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.