Individual
BLAKE D BESANCENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
12109 TESSON FERRY PROFESSIONAL CTR, SAINT LOUIS, MO 63128-1250
(314) 843-2078
Mailing address
12109 TESSON FERRY PROFESSIONAL CTR, SAINT LOUIS, MO 63128-1250
(314) 843-2078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2020023988
MO
Other
Enumeration date
08/07/2020
Last updated
11/17/2020
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