| Blake Dentistry, Pc | |
|
507 Dwight St Coudersport PA 16915-1792 | |
| (814) 274-7262 | |
| (814) 274-0879 |
| Full Name | Blake Dentistry, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 507 Dwight St, Coudersport, Pennsylvania |
| Authorized Official Name and Position | Shane Christopher Blake (PRESIDENT) |
| Authorized Official Contact | 8142747262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blake Dentistry, Pc 507 Dwight St Coudersport PA 16915-1792 Ph: (814) 274-7262 | Blake Dentistry, Pc 507 Dwight St Coudersport PA 16915-1792 Ph: (814) 274-7262 |
| NPI Number | 1962567644 |
|---|---|
| Provider Enumeration Date | 12/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962567644 | NPI | - | NPPES |
| 0019285420002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DS-035521 (Pennsylvania) | Primary |
Dr. Victor D. Brown, Dmd, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6 Niles Hill Rd, Coudersport, PA 16915 Phone: 814-274-1111 Fax: 814-274-7786 | |
Charles Cole Memorial Hospital D/b/a Upmc Cole Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1001 E 2nd St, Coudersport, PA 16915 Phone: 814-274-5252 |