Active NPI
Keith Allan Blalock, DDS,MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Helotes, TX
National Provider Identifier
1669482808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 15290
- Practice address
- 12340 Bandera Rd
Suite 102
Helotes, TX 78023-4574 - Phone
- (210) 695-9996
- Fax
- (210) 695-9566
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 15290 | TX | Primary |
Addresses
Primary practice location
12340 Bandera Rd
Suite 102
Helotes, TX 78023-4574
Mailing address
12340 Bandera Rd
Suite 102
Helotes, TX 78023-4574
Phone (210) 695-9996
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15290 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329264000000",
"number": "1669482808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12340 BANDERA RD",
"address_2": "SUITE 102",
"city": "HELOTES",
"state": "TX",
"postal_code": "780234574",
"telephone_number": "210-695-9996",
"fax_number": "210-695-9566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12340 BANDERA RD",
"address_2": "SUITE 102",
"city": "HELOTES",
"state": "TX",
"postal_code": "780234574",
"telephone_number": "210-695-9996",
"fax_number": "210-695-9566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLALOCK",
"first_name": "KEITH",
"middle_name": "ALLAN",
"credential": "DDS,MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2012-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TX",
"license": "15290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Helotes, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.