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Individual

DR. ALAN MAX BLAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
808 N 9TH ST, ESTHERVILLE, IA 51334-1534
(712) 362-5454
(712) 362-4737
Mailing address
808 N 9TH ST, ESTHERVILLE, IA 51334-1534
(712) 362-5454
(712) 362-4737

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
06008
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0052308
IA
01
06008
STATE DENTAL LICENSE
IA
Enumeration date
01/23/2007
Last updated
07/08/2007
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