Bluestone Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12242 Issued in MN

Legal business name

BLUESTONE DENTAL PLLC

Practice address

906 Woodland Avenue
Duluth, MN 55812-1113

Phone

(218) 606-1040

NPI assigned

Nov 24, 2015

Last updated

Nov 24, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Whitney Christine Hustad Davidson, DDSNPI 1720165905

Title

Owner

Phone

(218) 606-1040

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Whitney Christine Hustad Davidson, DDS

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1720165905
  NPD (past) Authorized official
• Nicole Nothongkham, DDS

  • Dentist
  • Hermantown, MN
  • NPI 1679202485
  NPD (past)

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

{
    "created_epoch": "1448323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448323200000",
    "number": "1801260187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 WOODLAND AVENUE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121113",
            "telephone_number": "218-606-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 WOODLAND AVENUE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121113",
            "telephone_number": "218-606-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESTONE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-24",
        "last_updated": "2015-11-24",
        "status": "A",
        "authorized_official_last_name": "HUSTAD DAVIDSON",
        "authorized_official_first_name": "WHITNEY",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-606-1040",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Leonard Bloom
• Zomi Louise Bloom
• Jill C Bloomer, RN
• Britta Natalie Bloomquist, LGSW
• Mark Nicholas Bloss, OTR/L
• Bluestone Oral and Maxillofacial Surgery, P.a.
• Melanie Ann Bluth, DDS
• Daniel Alejandro Bly Laguna
• Liv Petra Bly, PA-C
• Kimberly Anne Boddicker, MD

• General Practice Dentistry in Duluth, MN
• Providers in Duluth, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2015; 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.