Healthcare Provider Details

I. General information

NPI: 1922374164
Provider Name (Legal Business Name): BLAKE THOMAS LINDSEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 S MASON RD SUITE 120
RICHMOND TX
77406-5810
US

IV. Provider business mailing address

PO BOX 860036
MINNEAPOLIS MN
55486-0036
US

V. Phone/Fax

Practice location:
  • Phone: 855-853-7681
  • Fax:
Mailing address:
  • Phone: 832-595-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: