Individual
ALICIA NICOLE BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8200 W SILVER SPRING DR, MILWAUKEE, WI 53218-2552
(414) 760-3900
(414) 464-7258
Mailing address
430 W ERIE ST, STE 200, CHICAGO, IL 60654-6914
(920) 838-1649
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7031-15
WI
1223G0001X
General Practice Dentistry
Primary
7031-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100029377
—
WI
Enumeration date
08/10/2011
Last updated
07/03/2024
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