Philip Alan Blythe, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401004796 Issued in VA

Practice address

3872 Holland Rd
Virginia Beach, VA 23452-2824

Phone

(757) 463-0740

Fax

(757) 496-5724

NPI assigned

Aug 19, 2007

Last updated

Aug 19, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1187481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187481600000",
    "number": "1912190471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3872 HOLLAND RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234522824",
            "telephone_number": "757-463-0740",
            "fax_number": "757-496-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3872 HOLLAND RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234522824",
            "telephone_number": "757-463-0740",
            "fax_number": "757-496-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYTHE",
        "first_name": "PHILIP",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-19",
        "last_updated": "2007-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401004796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kinshasa Blue
• Bluesky Physical Therapy LLC
• Jada Alexis Bluford
• Julia S Blumenshine
• Karen M Blythe, COTA
• Tressa O Blythe, PMHNP
• Sarah Smith Boadway
• Board Certified Family Practice, Inc
• Destiny Boardley
• Dennis Boateng, PHARM D

• General Practice Dentistry in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.