Blake Latendresse, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7846 Issued in NE

Practice address

1004 Lincoln Rd Ste 100
Bellevue, NE 68005-2341

Phone

(402) 293-1176

NPI assigned

Jul 23, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658534400000",
    "number": "1285369157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6462 POPPLETON AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681061542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 LINCOLN RD STE 100",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680052341",
            "telephone_number": "402-293-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATENDRESSE",
        "first_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-23",
        "last_updated": "2022-07-23",
        "certification_date": "2022-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "7846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Ann Larsen, RN
• Alex Larson
• Maxwell Larweh, MD
• Felicia Lassek
• Brock R Lasure, M.D.
• Breana Grace Lawler
• Julia Lawrence
• Cierra Lawver
• Sagbo R Lay
• Kylie Layman

• General Practice Dentistry in Bellevue, NE
• Providers in Bellevue, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.