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General NPI Number Information
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NPI Number | 1871807941
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Entity Type | Individual
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Provider Name | JESSICA J. BLAKELY DDS
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Gender | Female
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Dates
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Enumeration Date | 08/01/2010
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 2746 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14214-1702
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Country | US
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Telephone | 716-249-4999
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Fax | 716-249-4999
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Provider Business Mailing Address
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Address Line | 5363 TRANSIT RD
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City | CLARENCE
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State | NY
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Zip | 14221
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Country | US
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Telephone | 716-320-1901
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Fax | 716-299-3390
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 055802
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License Number State | NY
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