RICHARD W BLAKE DDS PA NPI 1558701177

NPI Information

RICHARD W BLAKE DDS PA is a pediatric dentistry dentist in Jacksonville, FL. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. RICHARD W BLAKE DDS PA NPI is 1558701177. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

943 CESERY BLVD STE D
JACKSONVILLE, FL
ZIP 32211-655
Phone: (904) 743-2000
Fax: (904) 744-0598

The provider's authorized official is Richard Wayne Blake .
The authorized official title is Owner/president and has the following contact phone number 19047432000.

The enumeration date for this NPI number is 6/27/2013 and was last updated on 6/27/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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