Individual
SUMMER LYNN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
48703
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223X0400X
ORTHODONTIC NPI
CA
Enumeration date
09/10/2009
Last updated
03/24/2010
Update your record
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