Individual
DR. SHANE CHRISTOPHER BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
507 DWIGHT ST, COUDERSPORT, PA 16915-1792
(814) 274-7262
(800) 888-4760
Mailing address
507 DWIGHT ST, COUDERSPORT, PA 16915-1792
(814) 274-7262
(800) 888-4760
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS035521
PA
Other
Enumeration date
10/08/2012
Last updated
10/08/2012
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