| Dr Christopher Blake SC | |
|
17280 W North Ave Suite #102 Brookfield WI 53045-4336 | |
| (262) 789-9200 | |
| (262) 789-9213 |
| Full Name | Dr Christopher Blake SC |
|---|---|
| Speciality | Dentist |
| Location | 17280 W North Ave, Brookfield, Wisconsin |
| Authorized Official Name and Position | Christopher Allen Blake (DENTIST PRESIDENT OF SERVICE CORPOR) |
| Authorized Official Contact | 2627899200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Christopher Blake SC 17280 W North Ave Suite #102 Brookfield WI 53045-4336 Ph: (262) 789-9200 | Dr Christopher Blake SC 17280 W North Ave Suite #102 Brookfield WI 53045-4336 Ph: (262) 789-9200 |
| NPI Number | 1386783488 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 10/27/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386783488 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5002097015 (Wisconsin) | Primary |
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