Aaron James Blakely, D.M.D.
Individual provider Active NPI General Practice Dentistry · Havana, IL
NPI 1215096037 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215096037
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019-024184 (IL)
- Practice address
- 112 W Adams St
Havana, IL 62644-1337 - Phone
- (309) 543-6301
- Fax
- (309) 543-4958
- NPI assigned
- Dec 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-024184 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Liberty Dental, Inc | General Practice | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-024184 | IL | Yes |
Addresses
Primary practice location
112 W Adams St
Havana, IL 62644-1337
Mailing address
112 W Adams St
Havana, IL 62644-1337
Phone (309) 543-6301
Other providers in Havana, IL
- Trisha A Armstrong
- Elizabeth Ballinger
- Brittney Elizabeth Barlage
- Gail Behrends
- Brandi Nicole Behymer
- Bleem Family Chiropractic Inc
- Renold B Bleem
- Karen Faye Brauer
- Tracey Mae Canete
- Rachel Lynn Davenport
All providers in Havana, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.