Active NPI
Jay Maynard Blickenstaff, DDS
- Dentist
- Hagerstown, MD
National Provider Identifier
1376635391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- MD9244
- Practice address
- 2 Wayside Ave
Hagerstown, MD 21740-3994 - Phone
- (301) 733-9020
- Fax
- (301) 733-0136
- NPI assigned
- Sep 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | MD9244 | MD | Primary |
Addresses
Primary practice location
2 Wayside Ave
Hagerstown, MD 21740-3994
Mailing address
2 Wayside Ave
Hagerstown, MD 21740-3994
Phone (301) 733-9020
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 |
|---|---|---|---|
| MD9244 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376635391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 WAYSIDE AVE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217403994",
"telephone_number": "301-733-9020",
"fax_number": "301-733-0136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 WAYSIDE AVE",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217403994",
"telephone_number": "301-733-9020",
"fax_number": "301-733-0136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLICKENSTAFF",
"first_name": "JAY",
"middle_name": "MAYNARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "MD9244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
Sources for this page
- 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.