NPIMap

Organization Active NPI

J.Blake Perkins D.D.S. P.S.

Doing business as New Image Dentistry

  • Dentist
  • Vancouver, WA
National Provider Identifier
1568912426
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00008724 Issued in WA
Legal business name
J.BLAKE PERKINS D.D.S. P.S.
Doing business as
New Image Dentistry
Practice address
811 NE 112TH Ave
Suite 100
Vancouver, WA 98684-5115
Phone
(360) 604-7151
Fax
(360) 597-4562
NPI assigned
Oct 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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

Authorized official

Name
Dr. Justin Blake Perkins, D.D.S.NPI 1164417796
Title
Owner/Dentist
Phone
(360) 604-7151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DE00008724 WA Primary

Addresses

Primary practice location

811 NE 112TH Ave
Suite 100
Vancouver, WA 98684-5115

Mailing address

811 NE 112TH Ave
Suite 100
Vancouver, WA 98684-5115
Phone (360) 604-7151

Other identifiers 1

IdentifierTypeStateIssuer
1104084276OtherDME ONLY FOR MEDICARE

Other names 1

  • New Image Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

811 NE 112th Ave
Ste 100
Vancouver, WA 98684
Phone (360) 604-7151

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1568912426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 NE 112TH AVE",
            "address_2": "SUITE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986845115",
            "telephone_number": "360-604-7151",
            "fax_number": "360-597-4562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 NE 112TH AVE",
            "address_2": "SUITE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986845115",
            "telephone_number": "360-604-7151",
            "fax_number": "360-597-4562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J.BLAKE PERKINS D.D.S. P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "PERKINS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "360-604-7151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME ONLY FOR MEDICARE",
            "identifier": "1104084276",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Image Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; 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.