Individual
DR. CLINTON LARRY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
831 SIENA SPRINGS DR., NORMAN, OK 73071
(405) 392-4883
(405) 392-4889
Mailing address
2820 NW 32ND ST, NEWCASTLE, OK 73065-6576
(405) 392-4883
(405) 392-4889
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
4950075-9922
UT
1223G0001X
General Practice Dentistry
Primary
6330
OK
Other
Enumeration date
01/08/2007
Last updated
09/20/2011
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