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General NPI Number Information
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NPI Number | 1144338963
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Entity Type | Individual
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Provider Name | H. DWAINE BLAKEMAN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 1208 EAST BYERS AVE
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City | OWENSBORO
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State | KY
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Zip | 42303-7558
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Country | US
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Telephone | 270-926-3838
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Fax | 270-926-0452
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Provider Business Mailing Address
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Address Line | 745 SCHERM RD DENTAL ARTS BUILDING
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City | OWENSBORO
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State | KY
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Zip | 42301-6022
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Country | US
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Telephone | 270-926-9907
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Fax | 270-926-7801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4312
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License Number State | KY
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