Individual
DR. MELISSA KATHLEEN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
1924 ROUTE 70 E, CHERRY HILL, NJ 08003
(856) 783-0444
Mailing address
123 EVANS MILL LN, CHERRY HILL, NJ 08034-3555
(774) 251-1137
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22DI02767300
NJ
1223P0221X
Pediatric Dentistry
NC10725
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/21/2015
Last updated
07/17/2019
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