Healthcare Provider Details

I. General information

NPI: 1841121076
Provider Name (Legal Business Name): BLAKE CHRISTOPHER PETERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 STEEL AVE
ABERDEEN SD
57401-5521
US

IV. Provider business mailing address

710 13TH AVE SW
ABERDEEN SD
57401-6871
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-0261
  • Fax:
Mailing address:
  • Phone: 320-894-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1523
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: