Healthcare Provider Details

I. General information

NPI: 1043148562
Provider Name (Legal Business Name): BLAKE PAINTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 WORLEY DR
ALEXANDRIA LA
71301-3631
US

IV. Provider business mailing address

233 SAINT ANDREWS DR
ALEXANDRIA LA
71303-9721
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-8915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7842
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: