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General NPI Number Information
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NPI Number | 1619332764
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Entity Type | Organization
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Legal Business Name | BLAKE G. SINCLAIR, DDS II, P.A.
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 3801 NORTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2473
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Country | US
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Telephone | 936-560-2275
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Fax | 936-560-2270
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Provider Business Mailing Address
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Address Line | 3801 NORTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2473
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Country | US
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Telephone | 936-560-2275
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Fax | 936-560-2270
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Authorized Official
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Title or Position | MANAGING DENTIST
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Name | DAVID SIMMONS
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Credential |
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Telephone | 936-560-2275
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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 | 17163
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License Number State | TX
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