Scott Parker Blackhart, D.M.D.
Individual provider Active NPI Dentist · Oakdale, CA
NPI 1386952240 · NPPES record last updated Aug 31, 2015
Key facts
- NPI
- 1386952240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 59747 (CA)
- Practice address
- 1419 W F St
Oakdale, CA 95361-3502 - Phone
- (209) 847-0309
- Fax
- (209) 847-2391
- NPI assigned
- Sep 14, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160309002050 | CA | Order and Referring Only - Dentist |
7315243821 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59747 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Albertoni and Corso Dentistry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 59747 | CA | Yes |
Addresses
Primary practice location
1419 W F St
Oakdale, CA 95361-3502
Mailing address
1419 W F St
Oakdale, CA 95361-3502
Phone (209) 847-0309
Other providers in Oakdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.