Individual
DR. BLAKE EDWIN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2190 E BIDWELL ST, FOLSOM, CA 95630-6453
(916) 984-0304
Mailing address
2190 E BIDWELL ST, FOLSOM, CA 95630-6453
(916) 984-0304
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
64252
CA
Other
Enumeration date
10/05/2005
Last updated
12/25/2019
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