Individual
DR. ELIZABETH CLAIR BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
175 LITTLETON RD, WESTFORD, MA 01886-3196
(978) 392-9800
Mailing address
812 FRANKLIN ST APT B, WORCESTER, MA 01604-1785
(352) 262-9532
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN1855332
MA
390200000X
Student in an Organized Health Care Education/Training Program
DN 17644
FL
Other
Enumeration date
07/04/2007
Last updated
05/12/2010
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