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Individual

DR. TERRY MICHAEL BLAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS, MSD

Contact information

Practice address
225 SOUTH MAIN, SUITE 101, O'FALLON, MO 63366
(636) 272-6666
(636) 272-6661
Mailing address
225 SOUTH MAIN, SUITE 101, O'FALLON, MO 63366
(636) 272-6666
(636) 272-6661

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
011574
MO

Other

Enumeration date
06/18/2021
Last updated
06/18/2021
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