Individual
DR. BLAKE A SWIMMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
907 MORAGA RD, LAFAYETTE, CA 94549-4507
(925) 283-0114
Mailing address
907 MORAGA RD, LAFAYETTE, CA 94549-4507
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
102732
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102732
DENTAL LICENSE
CA
Enumeration date
09/25/2018
Last updated
09/25/2018
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