Individual
DR. BLAKE FERANDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
346 FORT ZUMWALT SQ, O FALLON, MO 63366-3065
(636) 978-6400
Mailing address
346 FORT ZUMWALT SQ, O FALLON, MO 63366-3065
(636) 978-6400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030670
IL
Other
Enumeration date
06/09/2016
Last updated
12/10/2018
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