MEDICARE: DR. BLAKE G SHREEVE DMD

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
1	1223G0001X	General Practice Dentistry	D07562	AZ
2	122300000X	Dentist	D7562	AZ

General Provider Information

NPI Number	:	1841454683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE G SHREEVE DMD

Provider Business Mailing Address
First Line	:	5225 S POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212
Country	:	US
Telephone Number	:	480-924-5577
Fax Number	:	480-924-5573

Provider Business Practice Location Address
First Line	:	5225 S POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212
Country	:	US
Telephone Number	:	480-924-5577
Fax Number	:	480-924-5573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	02/17/2026

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