DR. JACOB STEVEN BLACKHURST (NPI# 1154938520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154938520 |
| Entity Type | Individual |
| Full Name | DR. JACOB STEVEN BLACKHURST |
| Credential | DDS |
| Practice Address |
Bldg 4-1838 Normandy Dr Apo AA 28307-7302 |
| Mailing Address |
735 Exeter St Carthage NC 28327-1455 |
| Practice Telephone | 9104326190 |
| Mailing Telephone | 8016691992 |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
11821131-9922 | UT | Dental Providers |
| Street Address |
BLDG 4-1838 NORMANDY DR |
| City | APO |
| State | AA |
| Zip Code | 28307-7302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700498631 | Jaclyn Jennifer Willis | Dentist | Ardennes Street, Fort Bragg, NC 28307 | 2020-08-21 |
| 1003398850 | Bailey Moorhead | Dentist | Bldg C-6238 Ardennes Road, Fort Bragg, NC 28307 | 2018-08-29 |
| 1619454980 | Seth David Williams | Physician Assistant | Bldg C-1722 Tagatay Dr, Fort Bragg, NC 28307 | 2018-07-19 |
| 1134633894 | Ashley Andrick | Physician Assistant | 1722 Tagatay Dr, Fort Bragg, NC 28307 | 2017-11-16 |
| 1184144479 | Thomas William Hanna IIi | Dentist | Bldg C-6238 Ardennes St., Fort Bragg, NC 28307 | 2017-06-27 |
| 1720530355 | Robert Holly | Military Health Care Provider | 7606 Reilly Rd, Bldg 2, Fort Bragg, NC 28307 | 2016-10-31 |
| 1891246708 | Womack Army Medical Center | Pharmacy | 1571 Reilly Rd, Bldg 4, Ft Bragg, NC 28307 | 2016-10-17 |
| 1710319405 | Valerie D. Jefferys | Pharmacist | 2817 Reily Road Womack Army Medical Center, Apo, AE 28307 | 2013-08-05 |
| 1689976367 | Komkwuan Pholtavee Paruchabutr | Registered Nurse | Building 4-2817 Reilly Road, Fort Bragg, NC 28307 | 2010-12-01 |
| 1609032879 | Kristi Lyn Natalino | Physical Therapist | 2817 Reilly Rd Bldg 4, Physical Therapy Department, Fort Bragg, NC 28307 | 2008-08-06 |
| Find all providers in zip 28307 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669088852 | Matthew Dejong | Dentist | Kleber Dental Clinic, Bldg 3287, Apo, AE 09227 | 2020-09-22 |
| 1184236895 | Christina Belousov | Dentist | 14351 Battalion Ave, Apo, AA 76544 | 2020-08-24 |
| 1417503459 | Cooper Pasque | Dentist | 1838 Normandy Dr., Fort Bragg, Apo, AA 28310 | 2019-08-15 |
| 1659927937 | Benjamin Kyunghan Yoon | Dentist | 618th Dental Company, Carius Dental Clinic Unit #15652, Attn: Credentails Coordinator, Apo, AP 96271-5245 | 2019-08-13 |
| 1477108967 | Shane Clay Hoffner | Dentist | 618th Dental Co, Carius Dental Clinic Bldg# P3020, Attn: Credentials Office, Apo, AP 96271-5245 | 2019-08-02 |
| 1740848449 | Samuel Kong Hmong Lo | Dentist | Carius Dental Clinic, Unit 15652, Apo, AP 96271 | 2019-05-29 |
| 1437712130 | Andrea Rose Deese | Dentist | Raf Lakenheath 48 Mdg / Sghc, Unit 5115, Apo, AE 09461-5115 | 2019-04-17 |
| 1871052837 | Ryan Kenny Zarnowski | Dentist | 673 Mdg, 5955 Zeamer Avenue, Jber, Ak 99506, Apo, AA 99506 | 2019-03-18 |
| 1619440922 | Joo Park | Dentist | Cmr 402 Unit 33301, Apo, AE 09180 | 2019-01-09 |
| 1760962252 | Ian Alexander Milton | Dentist | Raf Lakenheath 48 Mdg/schc, Unit 5115, Apo, AE 09461-5115 | 2018-08-15 |
| Find all providers in APO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.