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NPI Code Detail

MEDICARE: DR. CHRISTOPHER SHAWN BLAKE D.M.D

MEDICARE: DR. CHRISTOPHER SHAWN BLAKE D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255138251
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER SHAWN BLAKE D.M.D
Provider Business Mailing Address
First Line : 3231 HARVEY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3231 HARVEY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3003
Country : US
Telephone Number : 513-584-6660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2025
Last Update Date : 02/26/2025

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