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General NPI Number Information
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NPI Number | 1295247674
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Entity Type | Organization
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Legal Business Name | BLAKE DREW DMD, PC
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 2215 NW SHEVLIN PARK RD STE 110
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City | BEND
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State | OR
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Zip | 97703-7195
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Country | US
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Telephone | 541-610-3270
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Fax | 541-279-2356
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Provider Business Mailing Address
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Address Line | 2323 NW HIGH LAKES LOOP
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City | BEND
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State | OR
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Zip | 97703-7056
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Country | US
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Telephone | 971-226-6029
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Fax | 541-279-2356
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BLAKE B DREW
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Credential | DMD
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Telephone | 971-226-6029
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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 | D9366
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License Number State | OR
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