NPIMap

Organization Active NPI

John Walton Blackman III DDS

  • General Practice Dentistry
  • Winston Salem, NC
National Provider Identifier
1790981330
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3165 Issued in NC
Legal business name
JOHN WALTON BLACKMAN III DDS
Practice address
1409 H Plaza West Rd
Winston Salem, NC 27103-1418
Phone
(336) 760-9258
Fax
(336) 659-9258
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. John Walton Blackman III, DDSNPI 1063637668
Title
Owner Dentist
Phone
(336) 760-9258

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3165 NC Primary

Addresses

Primary practice location

1409 H Plaza West Rd
Winston Salem, NC 27103-1418

Mailing address

1409 H Plaza West Rd
Winston Salem, NC 27103-1418
Phone (336) 760-9258

National Provider Directory

National Provider Directory

Locations

1409 Plaza West Rd
Ste H
Winston Salem, NC 27103
Phone (336) 760-9258

Practitioners & affiliated clinicians

Practitioners 2

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": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790981330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 H PLAZA WEST RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031418",
            "telephone_number": "336-760-9258",
            "fax_number": "336-659-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 H PLAZA WEST RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031418",
            "telephone_number": "336-760-9258",
            "fax_number": "336-659-9258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN WALTON BLACKMAN III DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACKMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WALTON",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "336-760-9258",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "3165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.