Individual
BLAKE GABRIEL LIVINGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13724 WOODWARD AVE, HIGHLAND PARK, MI 48203-3625
(313) 883-3050
Mailing address
13724 WOODWARD AVE, HIGHLAND PARK, MI 48203-3625
(313) 883-3050
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
20372
MI
1223G0001X
General Practice Dentistry
Primary
20372
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750677902
—
MI
Enumeration date
06/27/2011
Last updated
05/15/2015
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