MYA MARIE BLANCO, DMD — NPI 1083559413 (Licensed & Credentialed Student in an Organized Health Care Education/Training Program in LOUISVILLE, KY)

CMS-1500 Box 24J / 33a • NPI

1083559413

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

390200000X

Licensed & Credentialed Student in an Organized Health Care Education/Training Program

Box 32 Service Location & ZIP+4

501 S PRESTON ST, LOUISVILLE, KY, 40202-1701

✓ 9-Digit EDI 837 ZIP+4 (40202-1701)

Practice Phone & Referral Fax

(502) 852-5096

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1083559413 (MYA MARIE BLANCO, DMD) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1083559413` (NPI-1 Individual Practitioner)
Provider / Legal Name	MYA MARIE BLANCO, DMD
Plain-English Specialty	Licensed & Credentialed Student in an Organized Health Care Education/Training Program NUCC Code: `390200000X` (Student in an Organized Health Care Education/Training Program)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	501 S PRESTON ST, LOUISVILLE, KY, 40202-1701
Practice Telephone / Fax	Tel: (502) 852-5096
Administrative Mailing Address	3608 PARK PLACE DR, POLAND, OH, 44514-4235
Enumeration & Last Sync	Enumerated: 2026-04-22 \| CMS Record Updated: 2026-07-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

501 S PRESTON ST, LOUISVILLE, KY, 40202-1701

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Plain-English Taxonomy & CMS Crosswalk (390200000X)

What Does Taxonomy Code 390200000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 390200000X translates to:
"Licensed & Credentialed Student in an Organized Health Care Education/Training Program"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Student in an Organized Health Care Education/Training Program for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MYA MARIE BLANCO, DMD)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`390200000X` — Student in an Organized Health Care Education/Training Program Plain English: Licensed & Credentialed Student in an Organized Health Care Education/Training Program	State: KY \| License: `D-00259` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MYA MARIE BLANCO, DMD (NPI #1083559413)