Provider Demographics
NPI:1437210663
Name:CHILDERS, BLAKE COLLINS (DDS)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:COLLINS
Last Name:CHILDERS
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 1:2536 AMHERST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3207
Mailing Address - Country:US
Mailing Address - Phone:713-490-8880
Mailing Address - Fax:713-493-0376
Practice Address - Street 1:20135 HIGHWAY 59 N STE A
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2372
Practice Address - Country:US
Practice Address - Phone:281-441-9000
Practice Address - Fax:281-441-8900
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice