Provider Demographics
NPI:1457087934
Name:JOHN P. BLAKE DDS PC
Entity Type:Organization
Organization Name:JOHN P. BLAKE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-693-5800
Mailing Address - Street 1:1251 S LAPEER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1416
Mailing Address - Country:US
Mailing Address - Phone:248-693-5800
Mailing Address - Fax:
Practice Address - Street 1:1251 S LAPEER RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1416
Practice Address - Country:US
Practice Address - Phone:248-693-5800
Practice Address - Fax:248-693-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental