Devon James Blob, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

600150815 Issued in WI

Practice address

2563 E Calumet St
Appleton, WI 54915-4748

Phone

(920) 731-6416

NPI assigned

Jun 27, 2023

Last updated

Dec 20, 2024By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Daniel J. Johanek D.D.S.S.C.

  • Dentist
  • Appleton, WI
  • NPI 1972526325
  NPD (past)
• Dr. Park Dental Office 1, LLC

  dba Clear Lakes Dental

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1508594664
  NPD (past)

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1568148138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N9305 NOE RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549155653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2563 E CALUMET ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549154748",
            "telephone_number": "920-731-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOB",
        "first_name": "DEVON",
        "middle_name": "JAMES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-27",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "600150815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Blankenheim, OT, CHT
• Eric Blankenheim, OT
• Kathryn Augusta Blanker, MSW
• Lara A Bleck, PT
• Sydney E Blickhahn, SLP
• Emily Bloemer
• Kristine Nicole Blohowiak, RN
• Kim Blomster
• Ann Katharine Bloodgood, RPH
• Blue Feather, Inc. (Zounds of Appleton)

• General Practice Dentistry in Appleton, WI
• Providers in Appleton, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.