MEDICARE: BLAKE OBRINGER 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	122300000X	Dentist	30028457	OH

General Provider Information

NPI Number	:	1891628285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE OBRINGER DMD

Provider Business Mailing Address
First Line	:	807 CLEVELAND RD W
Second Line	:
City	:	HURON
State	:	OH
Zip	:	44839-1401
Country	:	US
Telephone Number	:	419-677-4972
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 EXECUTIVE DR
Second Line	:
City	:	NORWALK
State	:	OH
Zip	:	44857-9016
Country	:	US
Telephone Number	:	419-668-3606
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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