Individual
DR. KENNETH ERWIN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3400 SW 187TH AVE, SUITE 2, ALOHA, OR 97006-3131
(503) 642-2834
(503) 642-2834
Mailing address
3400 SW 187TH AVE, SUITE 2, ALOHA, OR 97006-3131
(503) 642-2834
(503) 642-2834
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5025
OR
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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