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General NPI Number Information
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NPI Number | 1194949511
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Entity Type | Organization
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Legal Business Name | DON BLAKESLEE DDS PA
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10155 UNIVERSITY AVE NE STE 112
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City | BLAINE
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State | MN
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Zip | 55434-8058
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Country | US
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Telephone | 763-784-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 10155 UNIVERSITY AVE NE SUITE 112
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City | BLAINE
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State | MN
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Zip | 55434-8058
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Country | US
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Telephone | 763-784-1214
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DON R BLAKESLEE
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Credential | DDS
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Telephone | 763-784-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9018
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License Number State | MN
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