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General NPI Number Information
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NPI Number | 1619585833
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Entity Type | Individual
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Provider Name | AHREN SCOTT BLAKE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | US ARMY DENTAL HEALTH ACTIVITY BUILDING 9900 LINCOLN STREET, SECOND FLOOR
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 SKYRIDGE DR
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City | ELGIN
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State | OK
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Zip | 73538-2366
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Country | US
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Telephone | 563-613-0907
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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 | DDS-09756
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 25514
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS-09756
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License Number State | IA
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