Individual
DR. ROBERT EDWARD BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
104 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 461-9931
(770) 461-9176
Mailing address
104 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 461-9931
(770) 461-9176
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7991
GA
Other
Enumeration date
08/04/2006
Last updated
07/08/2007
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