Individual
BLAKE ALLEN DICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3817 FAIRVIEW DR, OWENSBORO, KY 42303-2117
(270) 993-4076
Mailing address
3817 FAIRVIEW DR, OWENSBORO, KY 42303-2117
(270) 993-4076
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30.025303
OH
1223P0221X
Pediatric Dentistry
Primary
9952
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100568370
—
KY
Enumeration date
03/26/2017
Last updated
02/14/2023
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