DR. Shane Christopher Blake, D.M.D.

NPI #1023360609 in Coudersport, Pennsylvania

Provider Information

NPI Number: 1023360609
Entity Type: Individual
Name: DR. Shane Christopher Blake, D.M.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: D.M.D.
Enumeration Date: Oct 8, 2012
Last Updated: Oct 8, 2012

Practice Location

Address: 507 DWIGHT ST
City: Coudersport
State: Pennsylvania
ZIP Code: 16915-1792
Phone: (814) 274-7262

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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