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General NPI Number Information
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NPI Number | 1336030584
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Entity Type | Individual
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Provider Name | BLAKE SCHRECK
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 7933 STATE AVE # 100-101
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City | KANSAS CITY
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State | KS
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Zip | 66112-2468
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Country | US
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Telephone | 913-213-6973
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Fax |
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Provider Business Mailing Address
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Address Line | 380 W 22ND ST APT 214
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City | KANSAS CITY
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State | MO
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Zip | 64108-2052
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Country | US
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Telephone | 660-254-4422
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Fax |
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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 | 62384
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License Number State | KS
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