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General NPI Number Information
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NPI Number | 1497722268
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Entity Type | Individual
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Provider Name | JOHN ROBERT BLAKEMORE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 26777 LORAIN ROAD #600
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3222
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Country | US
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Telephone | 440-734-3131
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Fax | 440-734-3486
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Provider Business Mailing Address
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Address Line | 26777 LORAIN ROAD #600
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3222
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Country | US
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Telephone | 440-734-3131
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Fax | 440-734-3466
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30013848
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30.013848
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License Number State | OH
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