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General NPI Number Information
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NPI Number | 1972814606
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Entity Type | Individual
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Provider Name | BLAKE RYAN JONES DMD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 CORNERSTONE DR STE 200&203
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City | CARY
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State | NC
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Zip | 27519-8428
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Country | US
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Telephone | 919-468-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 505 DICKSON AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83402-2946
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Country | US
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Telephone | 208-346-0724
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D-4294
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License Number State | ID
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