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Shane Blake, D.M.D
NPI 1023360609 · on the registry since 2012 · sole proprietor
Practice
- Address
- 507 Dwight St
Coudersport, PA 16915 - Phone
- (814) 274-7262
- Fax
- (800) 888-4760
- Organisation at this address
- Blake Dentistry, Pc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- Dentist
122300000X
- Licence states on file
- PA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2012-10-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Pennsylvania