Blake, Richard Wayne

Blake, Richard Wayne is an individual health care provider with primary practice located at 2701 Park Dr Suite #1, Clearwater FL 33763-1021. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Blake, Richard Wayne can be contacted via phone (727) 796-2187.

Contact Information

Primary practice address
2701 Park Dr Suite #1 Clearwater FL 33763-1021
Phone: (727) 796-2187
Fax: (727) 791-7660
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 0005634 Florida

Profile Details

NPI number 1912921867
LBN Legal business name Blake, Richard Wayne
Credentials DDS PA
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912921867 NPPES
Florida MEDICAID 074223600

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