David Crockett Blythe Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2345 Issued in LA

Practice address

401 Liberty St
Houma, LA 70360-4617

Phone

(985) 851-3710

Fax

(985) 851-3711

NPI assigned

Dec 11, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730249541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 LIBERTY ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604617",
            "telephone_number": "985-851-3710",
            "fax_number": "985-851-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 LIBERTY ST",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703604617",
            "telephone_number": "985-851-3710",
            "fax_number": "985-851-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYTHE",
        "first_name": "DAVID",
        "middle_name": "CROCKETT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "2345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1823457",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristi Murphy Blood
• Robert Charles Blossman, M.D.
• Carmen Blouin
• Tori Blouin
• Andrea Blum, MOT
• Roye Beeson Boatner
• Luis Bogran-Reyes, M.D.
• Sheila N Bonin, NP
• Jennifer Wiemann Bonvillain, MCD, CCC-SLP
• Kibry Wayne Bonvillain, RPH

• Oral and Maxillofacial Surgery (Dentist) in Houma, LA
• Providers in Houma, LA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Louisiana

• 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.