Provider Demographics
NPI:1467463521
Name:MARSTON, BLAKE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:E
Last Name:MARSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9330 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2157
Mailing Address - Country:US
Mailing Address - Phone:858-484-6100
Mailing Address - Fax:858-484-8601
Practice Address - Street 1:9330 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2157
Practice Address - Country:US
Practice Address - Phone:858-484-6100
Practice Address - Fax:858-484-8601
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD66211223X0400X
CA559661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics