Provider Demographics
NPI:1972814606
Name:JONES, BLAKE RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:RYAN
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2946
Mailing Address - Country:US
Mailing Address - Phone:208-346-0724
Mailing Address - Fax:
Practice Address - Street 1:200 CORNERSTONE DR STE 200&203
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8428
Practice Address - Country:US
Practice Address - Phone:919-468-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist