CMS-1500 Box 24J / 33a • NPI
1235790593
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
122300000X (CMS C5)
Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)
Box 32 Service Location & ZIP+4
737 E 9TH ST, RECTOR, AR, 72461-2705
✓ 9-Digit EDI 837 ZIP+4 (72461-2705)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1235790593 (BRYAN BLACKSHARE DDS) 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
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1235790593 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | BRYAN BLACKSHARE DDS |
| Plain-English Specialty | Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: 122300000X (Dentist) |
| Certifying / Licensing Body | American Dental Association (ADA) / State Board of Dental Examiners |
| Practice Location Address | 737 E 9TH ST, RECTOR, AR, 72461-2705 |
| Practice Telephone / Fax | Tel: (870) 595-3463 | Fax: (870) 595-3208 |
| Administrative Mailing Address | PO BOX 363, RECTOR, AR, 72461-0363 |
| Enumeration & Last Sync | Enumerated: 2019-06-26 | CMS Record Updated: 2019-06-26 |
| Authorized Official | SAMMY BLACKSHARE (owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (122300000X)
What Does Taxonomy Code 122300000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 122300000X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (BRYAN BLACKSHARE DDS)
Typical CPT / Diagnostic Procedures:- Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
- Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions
- Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
- Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
122300000X — DentistPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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