Provider Demographics
NPI:1265658850
Name:ROBISON, BLAKE B (DDS, MA, MSD)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:B
Last Name:ROBISON
Suffix:
Gender:M
Credentials:DDS, MA, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S. HIGLEY RD #105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296
Mailing Address - Country:US
Mailing Address - Phone:480-888-7711
Mailing Address - Fax:480-888-2895
Practice Address - Street 1:1355 S. HIGLEY RD #105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:480-888-7711
Practice Address - Fax:480-888-2895
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553321223G0001X
AZD81051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice