Organization
CHILDREN'S DENTAL FOUNDATION
Active
Other names
CHILDREN'S DENTAL HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN BLAKE D.D.S. (DENTAL DIRECTOR)
(562) 933-3141
Entity
Organization
Contact information
Practice address
455 E COLUMBIA ST, LONG BEACH, CA 90806-1620
(562) 933-3141
(562) 933-2049
Mailing address
455 E COLUMBIA ST, LONG BEACH, CA 90806-1620
(562) 933-3141
(562) 933-2049
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
CA
1223G0001X
General Practice Dentistry
—
CA
1223P0221X
Pediatric Dentistry
—
CA
1223P0300X
Periodontics
—
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
CA
124Q00000X
Dental Hygienist
—
CA
126800000X
Dental Assistant
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G90360-01
DENTI-CAL PROVIDER NUMBER
CA
Enumeration date
02/23/2007
Last updated
09/11/2025
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