Blake Gabriel Livingston, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20372 Issued in MI

Practice address

13724 Woodward Ave
Highland Park, MI 48203-3625

Phone

(313) 883-3050

NPI assigned

Jun 27, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ronald a Livingston, DDS, PC

  • General Practice Dentistry
  • Highland Park, MI
  • NPI 1750671830
  NPD (past)

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1750677902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13724 WOODWARD AVE",
            "city": "HIGHLAND PARK",
            "state": "MI",
            "postal_code": "482033625",
            "telephone_number": "313-883-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13724 WOODWARD AVE",
            "city": "HIGHLAND PARK",
            "state": "MI",
            "postal_code": "482033625",
            "telephone_number": "313-883-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVINGSTON",
        "first_name": "BLAKE",
        "middle_name": "GABRIEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "20372",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "20372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750677902",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Le
• Ruby Lee
• Edwin Lindsey, CAC-M
• Janice Lindsey
• Adam Liparoto
• Ronald Anthony Livingston, DDS
• Eric Bernard Lowery
• Juliet Namugga Lukwago
• Maat-Pros
• Wally Sherman Mahar, M.D.

• General Practice Dentistry in Highland Park, MI
• Providers in Highland Park, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.