Individual
NICOLE ANN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH/DT
Contact information
Practice address
1400 LOOKOUT DR, NORTH MANKATO, MN 56003-2500
(507) 480-4646
Mailing address
1036 MARIE CT, NORTH MANKATO, MN 56003-3437
(507) 273-1499
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT-186
MN
Other
Enumeration date
07/22/2025
Last updated
07/24/2025
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