Individual
SHELLI BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3242 W 8TH ST, LOS ANGELES, CA 90005-2176
(213) 368-9779
Mailing address
3242 W. 8TH STREET, QUEENSCARE FAMILY CLINICS, LOS ANGELES, CA 90005
(213) 368-9779
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
14938
CA
Other
Enumeration date
11/26/2008
Last updated
11/26/2008
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