Individual
DR. BLAKE LATENDRESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1004 LINCOLN RD STE 100, BELLEVUE, NE 68005-2341
(402) 293-1176
Mailing address
6462 POPPLETON AVE, OMAHA, NE 68106-1542
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7846
NE
Other
Enumeration date
07/23/2022
Last updated
07/23/2022
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