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General NPI Number Information
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NPI Number | 1568987584
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Entity Type | Individual
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Provider Name | DAVID BLAKE NULL D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3820 SANDY FORKS DR
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City | KINGWOOD
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State | TX
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Zip | 77339-2618
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Country | US
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Telephone | 281-360-3307
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 HARMONY PARK XING
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City | SPRING
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State | TX
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Zip | 77386-4475
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 31706
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License Number State | TX
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