# J.BLAKE PERKINS D.D.S. P.S.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New Image Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568912426
- **Authorized official:** DR. JUSTIN BLAKE PERKINS D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (360) 604-7151

## Contact information

- **Practice address:** 811 NE 112TH AVE, SUITE 100, VANCOUVER, WA 98684-5115
- **Practice address phone:** (360) 604-7151
- **Practice address fax:** (360) 597-4562
- **Mailing address:** 811 NE 112TH AVE, SUITE 100, VANCOUVER, WA 98684-5115
- **Mailing address phone:** (360) 604-7151
- **Mailing address fax:** (360) 597-4562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE00008724 | WA | Yes |

## Other

- **Enumeration date:** 10/04/2016
- **Last updated:** 10/04/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1104084276 | DME ONLY FOR MEDICARE | — |