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Individual

ERNEST HUBBERT BLAKE, JR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
409 E ASH ST, PERRY, FL 32347-2104
(850) 223-2578
(850) 223-3047
Mailing address
535 JOHN KNOX RD, ATTN: CREDENTIALING, TALLAHASSEE, FL 32303-4117
(850) 385-4494
(850) 298-6050

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN-12127
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
071572700
FL
Enumeration date
10/16/2006
Last updated
02/06/2009
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