John R Blaich, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

014614 Issued in MO

Practice address

2700 Kanell Blvd
Poplar Bluff, MO 63901-3041

Phone

(573) 785-0111

NPI assigned

Dec 14, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Arts Group L.L.C

  • Durable Medical Equipment & Medical Supplies
  • Poplar Bluff, MO
  • NPI 1679138036
  NPD Authorized official
• George F. Blaich, DMD & Associates, PC

  • General Practice Dentistry
  • Poplar Bluff, MO
  • NPI 1700063005
  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1548322936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 KANELL BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013041",
            "telephone_number": "573-785-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 KANELL BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013041",
            "telephone_number": "573-785-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAICH",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "014614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Black River Medical Group, LLC
• Amy Denise Blackburn, MCD, CFY-SLP
• Malarie Blackwell, PHARMD
• George F Blaich IV, D.M.D.
• George Frederick Blaich V, D.D.S.
• Lauren E Blaich, D.D.S.
• Travis D Blaich, D.D.S.
• Elizabeth Marrie Bland
• Staci Blankenship, OTR/L
• Timothy Blankenship, O.D.

• General Practice Dentistry in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.