Provider Demographics
NPI:1497722268
Name:BLAKEMORE, JOHN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BLAKEMORE
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 1:26777 LORAIN ROAD
Mailing Address - Street 2:#600
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3222
Mailing Address - Country:US
Mailing Address - Phone:440-734-3131
Mailing Address - Fax:440-734-3466
Practice Address - Street 1:26777 LORAIN ROAD
Practice Address - Street 2:#600
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3222
Practice Address - Country:US
Practice Address - Phone:440-734-3131
Practice Address - Fax:440-734-3486
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300138481223S0112X
OH30.0138481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30013848OtherDENTAL
OH30013848OtherDENTAL
AB7721586OtherDEA
OHBL0456501Medicare PIN