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Organization
J.BLAKE PERKINS D.D.S. P.S.
Active
Organization
J.BLAKE PERKINS D.D.S. P.S.
Active
Other names
New Image Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN BLAKE PERKINS D.D.S. (OWNER/DENTIST)
(360) 604-7151
Entity
Organization
Contact information
Practice address
811 NE 112TH AVE, SUITE 100, VANCOUVER, WA 98684-5115
(360) 604-7151
(360) 597-4562
Mailing address
811 NE 112TH AVE, SUITE 100, VANCOUVER, WA 98684-5115
(360) 604-7151
(360) 597-4562
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00008724
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104084276
DME ONLY FOR MEDICARE
—
Enumeration date
10/04/2016
Last updated
10/04/2016
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