Healthcare Provider Details

I. General information

NPI: 1194216887
Provider Name (Legal Business Name): BLAKE CHANEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 BRIARGATE PKWY STE 240
COLORADO SPRINGS CO
80920-7844
US

IV. Provider business mailing address

4105 BRIARGATE PKWY STE 240
COLORADO SPRINGS CO
80920-7844
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-1584
  • Fax:
Mailing address:
  • Phone: 719-434-1584
  • Fax: 719-313-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN.00205868
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: