Individual provider Active NPI

Roy Alfred Lindblad, DDS

  • General Practice Dentistry
  • Farmington, CT
National Provider Identifier
1982757555
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5941 Issued in CT
Practice address
325 Main St
Farmington, CT 06032-2977
Phone
(860) 677-7753
Fax
(860) 676-0274
NPI assigned
Jan 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5941 CT Primary

Addresses

Primary practice location

325 Main St
Farmington, CT 06032-2977

Mailing address

325 Main St
Farmington, CT 06032-2977
Phone (860) 677-7753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20150709002082 CT Order and Referring Only - DentistPractitioner - Dentist 5991017519

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5941CTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982757555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322977",
            "telephone_number": "860-677-7753",
            "fax_number": "860-676-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322977",
            "telephone_number": "860-677-7753",
            "fax_number": "860-676-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINDBLAD",
        "first_name": "ROY",
        "middle_name": "ALFRED",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "5941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.