Provider Demographics
NPI:1558850271
Name:BLAKELEY, PHOEBE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:MARIE
Last Name:BLAKELEY
Suffix:
Gender:F
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:PSC 9
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123-9998
Mailing Address - Country:US
Mailing Address - Phone:312-458-3535
Mailing Address - Fax:
Practice Address - Street 1:PSC 9
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09123-9998
Practice Address - Country:US
Practice Address - Phone:314-458-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002036001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice