Provider Demographics
NPI:1023854874
Name:WOODS, BLAKE PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:PATRICK
Last Name:WOODS
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 1:1216 W LEXINGTON ST APT 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4111
Mailing Address - Country:US
Mailing Address - Phone:847-682-9963
Mailing Address - Fax:
Practice Address - Street 1:1699 E WOODFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4955
Practice Address - Country:US
Practice Address - Phone:224-571-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035308122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist