Active NPI
Conklin & Doersch DDS Inc
Doing business as Bluefield Dental Associates
- Dentist
- Bluefield, WV
National Provider Identifier
1972612588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- CONKLIN & DOERSCH DDS INC
- Doing business as
- Bluefield Dental Associates
- Practice address
- 1607 Maryland Ave
Bluefield, WV 24701 - Phone
- (304) 324-8703
- Fax
- (304) 324-8735
- NPI assigned
- Aug 29, 2006
- Last updated
- Sep 20, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Drema Southern
- Title
- Office Manager
- Phone
- (304) 324-8703
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NU | Primary |
Addresses
Primary practice location
1607 Maryland Ave
Bluefield, WV 24701
Mailing address
1607 Maryland Ave
Bluefield, WV 24701
Phone (304) 324-8703
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810002955 | Medicaid | WV |
Other names 1
- Bluefield Dental Associates
National Provider Directory
National Provider Directory- Tax ID family
- Bluefield Dental Associates
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
1607 Maryland Ave
Bluefield, WV 24701
Phone (304) 324-8703
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Dentist
- Charleston, WV
- NPI 1649381492
-
- Dentist
- Bluefield, WV
- NPI 1033220892
-
- General Practice Dentistry
- Bluefield, WV
- NPI 1477623007
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1348099200000",
"number": "1972612588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1607 MARYLAND AVE",
"city": "BLUEFIELD",
"state": "WV",
"postal_code": "24701",
"telephone_number": "304-324-8703",
"fax_number": "304-324-8735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1607 MARYLAND AVE",
"city": "BLUEFIELD",
"state": "WV",
"postal_code": "24701",
"telephone_number": "304-324-8703",
"fax_number": "304-324-8735"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONKLIN & DOERSCH DDS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-29",
"last_updated": "2012-09-20",
"status": "A",
"authorized_official_last_name": "SOUTHERN",
"authorized_official_first_name": "DREMA",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "304-324-8703"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810002955",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bluefield Dental Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bluefield, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.