Blasingame Dental Corporation

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

BLASINGAME DENTAL CORPORATION

Practice address

4545 Quail Lakes Dr
Stockton, CA 95207-5257

Phone

(530) 241-3302

NPI assigned

Mar 7, 2024

Organization subpart

No

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

Authorized official

Name

Michelle Peters

Title

Insurance Billing Coordinator

Phone

(530) 241-3302

Specialties & licenses 1

Addresses

Other names 1

• Team Perio Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Liska, DDS

  • Periodontics
  • Redding, CA
  • NPI 1891207015
  NPD

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1508624222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 HARTNELL AVE STE A",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960021884",
            "telephone_number": "530-241-3302",
            "fax_number": "530-241-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 QUAIL LAKES DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075257",
            "telephone_number": "530-241-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLASINGAME DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "INSURANCE BILLING COORDINATOR",
        "authorized_official_telephone_number": "530-241-3302"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Perio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guadalupe Blanco
• Roy L Blanco, APRN,MSN,FNP-C,PA-C
• Georgia Beth Bland, PH.D.
• Kristen Blankenship
• Steven Frank Blankenship Jr., RDN
• Cecelia R Blawie, MD
• Rashenda Bledsaw
• Sarah Blessinger, OT
• Dewey Blevins
• Jenna Nicole Blewett, LMFT

• Periodontics in Stockton, CA
• Providers in Stockton, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.