Blake K Anderson DMD LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BLAKE K ANDERSON DMD LLC

Doing business as

A Street Dental

Practice address

828 NE a St
Grants Pass, OR 97526-2212

Phone

(541) 476-9792

NPI assigned

May 14, 2021

Last updated

May 14, 2021By 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. Blake K Anderson, DMDNPI 1235713140

Title

Doctor/Owner

Phone

(916) 765-7036

Specialties & licenses 1

Addresses

Other names 1

• A Street Dental Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Blake Kevin Anderson, DMD

  • Dentist
  • Grants Pass, OR
  • NPI 1235713140
  NPD Authorized official
• Caroline Leibrecht, DMD

  • General Practice Dentistry
  • Grants Pass, OR
  • NPI 1174417745
  NPD

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

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1912571027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4674 E FOXWOOD DR",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840056176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 NE A ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262212",
            "telephone_number": "541-476-9792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE K ANDERSON DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-14",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "916-765-7036",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon Renae Bjarnson
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• Miranda Black, L.AC.
• Jennifer E Blackmon
• Ricci Blackmon
• Blanchard Counseling Services LLC
• Derrick Blanchard, PA-C
• Tamra Blanchard, LPC
• Blissful Being Wellness, LLC
• Blomstra Behavioral Health, LLC

• Dental Clinic/Center in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.