Thomas Lagrand Blaisdell, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4079 Issued in ID

Practice address

1916 Ellis Ave
Caldwell, ID 83605-4811

Phone

(208) 459-2376

Fax

(208) 459-1524

NPI assigned

Jun 28, 2007

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

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437356029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 LARKSPUR CT",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836056294",
            "telephone_number": "208-402-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 ELLIS AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054811",
            "telephone_number": "208-459-2376",
            "fax_number": "208-459-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAISDELL",
        "first_name": "THOMAS",
        "middle_name": "LAGRAND",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J'Cinda J'Nae Bitters, MD
• Amy Jo Bizik, PMHNP
• William Thomas Black, OD
• Blaisdell Dental Center, PA
• John David Blaisdell, D.D.S.
• Jessica D Blancett, DO
• Sierra Faith Blanke
• Harrison Davis Blanton, MD
• Kelsey Lynne Blazicevich, LPC
• Richard E. Blood II, LPC

• General Practice Dentistry in Caldwell, ID
• Providers in Caldwell, ID by specialty
• General Practice Dentistry in Idaho

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.