Active NPI
Merissa Blais, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Forest Hills, NY
National Provider Identifier
1861641078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 054501-1
- Practice address
- 11316 76TH Rd # 1
Forest Hills, NY 11375-7236 - Phone
- (401) 762-1919
- NPI assigned
- Sep 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 054501-1 | NY | Primary |
Addresses
Primary practice location
11316 76TH Rd # 1
Forest Hills, NY 11375-7236
Mailing address
77 Havemeyer LN
Unit 90
Stamford, CT 06902-2153
Phone (401) 263-5113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 054501-1 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463443200000",
"number": "1861641078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 HAVEMEYER LN",
"address_2": "UNIT 90",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069022153",
"telephone_number": "401-263-5113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11316 76TH RD # 1",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113757236",
"telephone_number": "401-762-1919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAIS",
"first_name": "MERISSA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-11",
"last_updated": "2016-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "054501-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.