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General NPI Number Information
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NPI Number | 1679914782
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Entity Type | Organization
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Legal Business Name | CAROL A BLAKE, DDS, PLLC
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 5225 WISCONSIN AVE NW SUITE 511
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City | WASHINGTON
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State | DC
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Zip | 20015-2014
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Country | US
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Telephone | 202-966-0620
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Fax | 202-966-1509
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Provider Business Mailing Address
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Address Line | 5225 WISCONSIN AVE NW SUITE 511
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City | WASHINGTON
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State | DC
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Zip | 20015-2014
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Country | US
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Telephone | 202-966-0620
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Fax | 202-966-1509
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CAROL A BLAKE
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Credential | DDS
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Telephone | 202-966-0620
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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 | 5133
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License Number State | DC
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