Individual provider Active NPI

Blake Eaton, DDS

  • Student in an Organized Health Care Education/Training Program
  • Augusta, GA
National Provider Identifier
1679273395
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1120 15TH St # Gc5110
Augusta, GA 30912-0004
Phone
(307) 349-9193
NPI assigned
Mar 9, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1120 15TH St # Gc5110
Augusta, GA 30912-0004

Mailing address

720 University VLG
Salt Lake City, UT 84108-3431
Phone (307) 349-9193

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

NPI Registry JSON

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1679273395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 UNIVERSITY VLG",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841083431",
            "telephone_number": "307-349-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH ST # GC5110",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "307-349-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATON",
        "first_name": "BLAKE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-09",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.