# JUPITER PROSTHODONTICS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jupiter Institute for Prosthodontics & Implant Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114006434
- **Authorized official:** DR. ROY C BLAKE III DDS MSD (OWNER MANAGER)
- **Authorized official phone:** (561) 745-5550

## Contact information

- **Practice address:** 200 CENTRAL BLVD, STE A, JUPITER, FL 33458
- **Practice address phone:** (561) 745-5550
- **Practice address fax:** (561) 745-8442
- **Mailing address:** 200 CENTRAL BLVD, STE A, JUPITER, FL 33458
- **Mailing address phone:** (561) 745-5550
- **Mailing address fax:** (561) 745-8442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | DN16512 | FL | — |
| 1223P0700X | Prosthodontics | DN9551 | FL | Yes |

## Other

- **Enumeration date:** 11/06/2006
- **Last updated:** 08/22/2020