Blairsville Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012542 Issued in GA

Legal business name

BLAIRSVILLE DENTISTRY, LLC

Practice address

10 Deer Crossing Trce
Blairsville, GA 30512-1496

Phone

(706) 781-3340

NPI assigned

Mar 10, 2016

Last updated

Mar 10, 2016By 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

Dr. Peter Boulden

Title

Owner

Phone

(706) 781-3340

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1457568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1871954479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DEER CROSSING TRCE",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305121496",
            "telephone_number": "706-781-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DEER CROSSING TRCE",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305121496",
            "telephone_number": "706-781-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAIRSVILLE DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-10",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "BOULDEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-781-3340",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lonnie E Bass, CRNA
• Courtney Lee Bennett Wilke, PA-C
• Rachel Victoria Benson, PHYSICIAN ASSISTANT
• Betty Jo Scharer, LPC, LLC
• Blair House Dental, LLC
• Blairsville Family Practice, PC
• Jamie Rivkin Blalock, MS, APRN, FNP-C
• Jonathan A Bloch, MD
• Kathryn Blocker, M.D.
• Blue Ridge Orthopedics Inc.

• General Practice Dentistry in Blairsville, GA
• Providers in Blairsville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.

Verify at the official NPI Registry.