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Individual
SCOTT M BLAKE
Active
Individual
SCOTT M BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
D3728
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010143970
REGENCE BLUE SHIELD
ID
05
—
118557800
—
WY
01
—
1504752
UNITED CONCORDIA
ID
01
—
6I468
FEDERAL BLUE CROSS
ID
05
—
806657300
—
ID
05
—
806720800
—
ID
Enumeration date
02/12/2007
Last updated
10/15/2015
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