Individual
DR. BLAKE JAMES WILLOUGHBY II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3400 BURNS RD STE 100, PALM BEACH GARDENS, FL 33410-4352
(561) 627-2122
Mailing address
63 HICKORY HILL RD, TEQUESTA, FL 33469-2125
(636) 236-3177
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN24534
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2019
Last updated
03/07/2023
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