# H.C. BLAKE, III D.D.S. PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780899500
- **Authorized official:** HENRY CHRISTOPHER BLAKE III D.D.S. (PRESIDENT)
- **Authorized official phone:** (910) 762-8245

## Contact information

- **Practice address:** 1802A NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5350
- **Practice address phone:** (910) 762-8245
- **Practice address fax:** (910) 763-2093
- **Mailing address:** 1802A NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5350
- **Mailing address phone:** (910) 762-8245
- **Mailing address fax:** (910) 763-2093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | NC5127 | NC | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8990804 | — | NC |