Provider Demographics
NPI:1821184821
Name:BLAKELEY, MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BLAKELEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GROSS
Other - Last Name:KISSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9400 STATION ST
Mailing Address - Street 2:SUITE 175
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6808
Mailing Address - Country:US
Mailing Address - Phone:303-779-2797
Mailing Address - Fax:303-779-2687
Practice Address - Street 1:9400 STATION ST
Practice Address - Street 2:SUITE 175
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6808
Practice Address - Country:US
Practice Address - Phone:303-779-2797
Practice Address - Fax:303-779-2687
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice