Provider Demographics
NPI:1922797414
Name:BLAKE HULT DDS PLLC
Entity Type:Organization
Organization Name:BLAKE HULT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HULT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-880-1461
Mailing Address - Street 1:415 16TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-8688
Mailing Address - Country:US
Mailing Address - Phone:605-886-2222
Mailing Address - Fax:
Practice Address - Street 1:415 16TH AVE NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-8688
Practice Address - Country:US
Practice Address - Phone:605-886-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental