Healthcare Provider Details

I. General information

NPI: 1437210663
Provider Name (Legal Business Name): BLAKE COLLINS CHILDERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20135 HIGHWAY 59 N STE A
HUMBLE TX
77338-2372
US

IV. Provider business mailing address

2536 AMHERST ST STE A
HOUSTON TX
77005-3207
US

V. Phone/Fax

Practice location:
  • Phone: 281-441-9000
  • Fax: 281-441-8900
Mailing address:
  • Phone: 713-490-8880
  • Fax: 713-493-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: