WD Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42123 Issued in CA

Legal business name

WD DENTAL

Practice address

855 Third Ave.Suite#2230
Chula Vista, CA 91910-1350

Phone

(619) 409-1444

Fax

(619) 409-1496

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Burch Lee Blackstock, D.D.S.

Title

Dentist

Phone

(619) 409-1444

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417168923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 THIRD AVE.SUITE#2230",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919101350",
            "telephone_number": "619-409-1444",
            "fax_number": "619-409-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 THIRD AVE.SUITE#2230",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919101350",
            "telephone_number": "619-409-1444",
            "fax_number": "619-409-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WD DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACKSTOCK",
        "authorized_official_first_name": "BURCH",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "619-409-1444",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Patrick Waters, MD
• Paula Ynez Waters
• David Watkins, OTR/L
• Linda Watson
• Mandy Lynn Watts, PT, DPT, ATC
• Jhosmara Weaver
• Owen Weber
• Ruthann Weber
• Wecare Healthcare Group LLC
• Sabrina Weddle

• General Practice Dentistry in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.