Provider Demographics
NPI:1073763876
Name:COMEAUX, BLAKE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:A
Last Name:COMEAUX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3773
Mailing Address - Country:US
Mailing Address - Phone:337-367-2211
Mailing Address - Fax:337-367-2213
Practice Address - Street 1:441 CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3773
Practice Address - Country:US
Practice Address - Phone:337-367-2211
Practice Address - Fax:337-367-2213
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice