Elizabeth Blavatsky, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1835 Issued in MT

Practice address

422 S Main St
Livingston, MT 59047-3456

Phone

(406) 222-6061

Fax

(406) 222-6062

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679627699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 S MAIN ST",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "590473456",
            "telephone_number": "406-222-6061",
            "fax_number": "406-222-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 S MAIN ST",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "590473456",
            "telephone_number": "406-222-6061",
            "fax_number": "406-222-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAVATSKY",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "1835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0130624",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIP",
            "identifier": "5511051",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Livingston, MT
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.