Richard Blackburn, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

104972 Issued in CA

Practice address

3532 Howard Ave Ste 200
Los Alamitos, CA 90720-3699

Phone

(562) 501-3188

NPI assigned

Jun 22, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 11

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Midwestern University College of Dental Medicine, Glendale, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Richard Blackburn DMD, Inc

  • Dentist
  • Los Alamitos, CA
  • NPI 1457023921
  Medicare reassignment NPD Authorized official
• Blackburn WC DMD

  • Dentist
  • Los Alamitos, CA
  • NPI 1982490397
  NPD Authorized official

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772755200000",
    "number": "1891215760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3532 HOWARD AVE STE 200",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203699",
            "telephone_number": "562-596-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3532 HOWARD AVE STE 200",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203699",
            "telephone_number": "562-501-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-22",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0008X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "104972",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "104972",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "104972",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Black
• Blackburn WC DMD
• Stan R. Blackwell, A.B.O.C.
• Blessed Palliative and Hospice Service
• Wendy Nan Block, L.C.S,W.
• Myron J Bloom, MD
• Lawrence Neil Blum, PHD

• Dentist in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.