Individual
BLAKE MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1355 MIDDLETOWN AVE, NORTHFORD, CT 06472-1382
(203) 484-0456
Mailing address
22 LATHAM RD, WILLINGTON, CT 06279-1914
(860) 341-6441
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13368
CT
Other
Enumeration date
02/24/2021
Last updated
07/07/2023
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