Provider Demographics
NPI:1841866969
Name:VIDRINE, BLAKE JUDE II (DDS)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:JUDE
Last Name:VIDRINE
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2008
Mailing Address - Country:US
Mailing Address - Phone:337-581-5791
Mailing Address - Fax:
Practice Address - Street 1:10330 AIRLINE HWY STE A6
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4191
Practice Address - Country:US
Practice Address - Phone:225-308-8000
Practice Address - Fax:225-308-8000
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006879-C11223G0001X
LA72271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice