Provider Demographics
NPI:1205092954
Name:DREW, BLAKE BRANDT (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:BRANDT
Last Name:DREW
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 1:2215 NW SHEVLIN PARK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7108
Mailing Address - Country:US
Mailing Address - Phone:541-610-3270
Mailing Address - Fax:
Practice Address - Street 1:2215 NW SHEVLIN PARK RD STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7108
Practice Address - Country:US
Practice Address - Phone:541-610-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice