Gary Blyleven, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D-4574 Issued in ID

Practice address

9900 Lincoln Street 2ND Floor
Tacoma, WA 98431-0001

Phone

(253) 967-5271

NPI assigned

Jul 30, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Eisenhower Army Medical Center

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Fort Gordon, GA
  • NPI 1588868848
  NPD (past)

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

{
    "created_epoch": "1406678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1942618251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 LINCOLN STREET 2ND FLOOR",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 LINCOLN STREET 2ND FLOOR",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-967-5271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYLEVEN",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-30",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D-4574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Med Inc.
• Blue Mountain Medical Inc
• Blue Wave Eye Doctors Professional Limited Liability Company
• Jessa Grace Blumer
• Shane Blunk, MD
• Stevie N Boardman, CBT
• Mary Boben, BS, RC
• Monique Bobila-Korbel
• Andrey Bobrovnikov, CRNA
• Leanne Alicia Bocking

• Periodontics in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; 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.