George Frederick Blaich V, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

016156 Issued in MO

Practice address

821 W Pine St
Poplar Bluff, MO 63901-4956

Phone

(573) 785-6434

Fax

(573) 785-3840

NPI assigned

May 27, 2010

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 names 1

• Dr. Eric Blaich Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 20, 2023 through Sep 20, 2027

Medicare enrollment (NPD)

Not 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.

• Daniel Jackson DDS PC

  • General Practice Dentistry
  • Poplar Bluff, MO
  • NPI 1225205362
  NPD (past)

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1871812073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 W PINE ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014956",
            "telephone_number": "573-785-6434",
            "fax_number": "573-785-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 W PINE ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014956",
            "telephone_number": "573-785-6434",
            "fax_number": "573-785-3840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAICH",
        "first_name": "GEORGE",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "name_suffix": "V",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-27",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "016156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIC",
            "last_name": "BLAICH",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Black River Medical Center
• Black River Medical Group, LLC
• Amy Denise Blackburn, MCD, CFY-SLP
• Malarie Blackwell, PHARMD
• George F Blaich IV, D.M.D.
• John R Blaich, D.M.D.
• Lauren E Blaich, D.D.S.
• Travis D Blaich, D.D.S.
• Elizabeth Marrie Bland
• Staci Blankenship, OTR/L

• General Practice Dentistry in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.