NPIMap

Organization Active NPI

Blackstone Dental PLLC

  • Dentist
  • Salt Lake City, UT
National Provider Identifier
1700209699
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7386388-9922 Issued in UT
Legal business name
BLACKSTONE DENTAL PLLC
Practice address
6710 S Blackstone Rd
Salt Lake City, UT 84121-6072
Phone
(801) 278-0458
Fax
(801) 278-0460
NPI assigned
Jan 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Authorized official

Name
Dr. Brian Black
Title
Owner
Phone
(801) 278-0458

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7386388-9922 UT Primary

Addresses

Primary practice location

6710 S Blackstone Rd
Salt Lake City, UT 84121-6072

Mailing address

6710 S Blackstone Rd
Salt Lake City, UT 84121-6072
Phone (801) 278-0458

National Provider Directory

National Provider Directory

Locations

6710 S Blackstone Rd
Salt Lake City, UT 84121
Phone (801) 278-0458

Practitioners & affiliated clinicians

Practitioners 1

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": "1390867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1700209699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6710 S BLACKSTONE RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216072",
            "telephone_number": "801-278-0458",
            "fax_number": "801-278-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6710 S BLACKSTONE RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216072",
            "telephone_number": "801-278-0458",
            "fax_number": "801-278-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSTONE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-28",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-278-0458",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "7386388-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; 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.