RICHARD W BLAKE DDS PA (NPI# 1558701177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558701177 |
| Entity Type | Organization |
| Organization Name | RICHARD W BLAKE DDS PA |
| Practice Address |
943 Cesery Blvd Ste D Jacksonville FL 32211-5655 |
| Practice Telephone | 9047432000 |
| Practice Fax Number | 9047440598 |
| Mailing Telephone | 9047432000 |
| Mailing Fax Number | 9047440598 |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2013-06-27 |
| Authorized Official Name | DR. RICHARD WAYNE BLAKE (OWNER/PRESIDENT) |
| Authorized Official Telephone | 19047432000 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
0005634 | FL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 074223600 | 05 |
| Street Address |
943 CESERY BLVD STE D |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32211-5655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457951758 | Ebs Childrens Therapy - Fl LLC | Behavioral Analyst | 5491 Dolphin Point Blvd, Jacksonville, FL 32211 | 2020-10-27 |
| 1700412822 | Marie Vernal | Social Worker | 6051 Arlington Expressway Suite 169, Jacksonville, FL 32211 | 2020-03-20 |
| 1992336895 | Dolphin Pointe Health Care, LLC | Skilled Nursing Facility | 5355 Dolphin Point Rd., Jacksonville, FL 32211 | 2020-01-29 |
| 1366089641 | Prophetic Healing Deliverance Ministry of Mysteries, Inc | Counselor | 8550-2 Lone Star Road, Jacksonville, FL 32211 | 2019-12-05 |
| 1922656370 | Timothy Richard Barron | Behavior Technician | 5633 Clifton Ln, Jacksonville, FL 32211 | 2019-08-29 |
| 1023583325 | Linnzi Marks | Behavioral Analyst | 6014 Wateredge Ln, Jacksonville, FL 32211 | 2018-10-12 |
| 1780160192 | Ganesh Healthcare of Jax LLC | Alzheimer Center (Dementia Center) | 644 Cesery Blvd Ste 150, Jacksonville, FL 32211 | 2018-07-18 |
| 1902397276 | Chandra Harris Washington | In Home Supportive Care | 2712 Gaillardia Rd, Jacksonville, FL 32211 | 2018-05-22 |
| 1043730062 | Monica R Iskander | Dentist | 465 University Blvd N, Jacksonville, FL 32211 | 2017-06-21 |
| 1205366895 | Lilibeth Bundang Adona | Custodial Care Facility | 1818 Townsend Blvd, Jacksonville, FL 32211 | 2017-06-15 |
| Find all providers in zip 32211 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336405315 | Matthew Allen Swan | Dentist | 3714 Heath Rd Fl 32277, Jacksonville, FL 32277-2045 | 2012-04-04 |
| 1215208947 | Culberson R Boren Dds | Dentist | 1634 S Jackson St, Jacksonville, TX 75766-3028 | 2012-01-26 |
| 1871755512 | Barry Philip Setzer | Dentist | 8355 Bayberry Rd, Jacksonville, FL 32256-4427 | 2008-06-25 |
| 1639370216 | Thomas Arch Pribisco | Dentist | 10822 Saint Augustine Rd, Jacksonville, FL 32257-1154 | 2007-05-30 |
| 1932317922 | Jodi Eve Mason | Dentist | 2008 Riverside Ave, Suite 101, Jacksonville, FL 32204-4443 | 2007-05-21 |
| 1679606768 | Marzieh Zahedi | Dentist | 14453 Beach Blvd, Suite 100, Jacksonville, FL 32250 | 2007-03-14 |
| 1780734251 | Jila J Mahajan | Dentist | 4495 Roosevelt Blvd Ste 111, Jacksonville, FL 32210-3382 | 2007-01-10 |
| 1558467498 | Barry P Setzer Dds and Stephen D Cochran Dmd Pa | Dentist | 8355 Bayberry Road, Jacksonville, FL 32256 | 2006-09-16 |
| 1912014937 | Pediatric Smiles, Inc | Dentist | 2262 Dunn Ave, Ste 4, Jacksonville, FL 32218 | 2006-08-24 |
| 1558477414 | Staci Suggs | Dentist | 1651 Southside Connector Blvd., #1, Jacksonville, FL 32225 | 2006-08-22 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32211 |
Please comment or provide details below to improve the information on RICHARD W BLAKE DDS PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.