Organization
J.BLAKE PERKINS D.D.S. P.S.
Active
Other names
New Image Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN BLAKE PERKINS D.D.S. (OWNER/DENTIST)
(360) 604-7151
Entity
Organization
Contact information
Practice address
811 NE 112TH AVE, SUITE 100, VANCOUVER, WA 98684-5115
(360) 604-7151
(360) 597-4562
Mailing address
811 NE 112TH AVE, SUITE 100, VANCOUVER, WA 98684-5115
(360) 604-7151
(360) 597-4562
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00008724
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104084276
DME ONLY FOR MEDICARE
—
Enumeration date
10/04/2016
Last updated
10/04/2016
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