Nathon Allan Blackburn, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

100534 Issued in AK

Practice address

4341 Tudor Centre Dr
Fireweed Dental
Anchorage, AK 99508-5904

Phone

(907) 729-2000

Fax

(907) 729-5178

NPI assigned

Feb 27, 2015

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 TX

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

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

{
    "created_epoch": "1424995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1477945400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35151",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245151",
            "telephone_number": "907-317-6070",
            "fax_number": "817-977-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4341 TUDOR CENTRE DR",
            "address_2": "FIREWEED DENTAL",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085904",
            "telephone_number": "907-729-2000",
            "fax_number": "907-729-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "NATHON",
        "middle_name": "ALLAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-27",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "100534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Bixler, PHARMD
• James Stanley Bjornson, PT
• Keri Blace
• Shannon Black
• Emily Blackburn, RN
• Ray Blackford, OPTICIAN
• Lyndall Shayne Blackmon, PHARMD
• Jannet Blackwell, R.N.
• Jennifer Blackwell, MPAS, PA-C
• Kenneth Blackwell, LMT

• All providers in Anchorage, AK
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; 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.