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General NPI Number Information
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NPI Number | 1851423313
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Entity Type | Individual
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Provider Name | LAWRENCE DAVID BLAKE DDS
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Gender | Male
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1745 W GRANDVIEW BLVD
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City | ERIE
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State | PA
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Zip | 16509-1101
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Country | US
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Telephone | 814-868-5197
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Fax | 814-868-3425
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Provider Business Mailing Address
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Address Line | 5139 RIDGEDALE DR
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City | ERIE
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State | PA
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Zip | 16506-6115
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Country | US
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Telephone | 814-833-4884
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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 | DS019300-L
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License Number State | PA
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