BLAKE GABRIEL LIVINGSTON DDS NPI 1750677902

NPI Information

NPI: 1750677902
Provider Name: BLAKE GABRIEL LIVINGSTON, DDS
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

PECOS Registration: Yes

Address:
13724 WOODWARD AVE
HIGHLAND PARK, MI
ZIP 48203
Phone: (313) 883-3050
Get Directions

Blake Gabriel Livingston, DDS is a general practice dentist in Highland Park, MI. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. Blake Gabriel Livingston, DDS NPI is 1750677902. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

13724 WOODWARD AVE
HIGHLAND PARK, MI
ZIP 48203-625
Phone: (313) 883-3050

The NPI 1750677902 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/27/2011 and was last updated on 5/15/2015.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist		20372	MICHIGAN	No
2	1223G0001X	Dentist	General Practice	20372	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1750677902	MEDICAID	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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