Blake Alexander Crosby, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN26120 Issued in FL

Practice address

320 Avenue K SE Ste 1
Winter Haven, FL 33880-4148

Phone

(863) 293-5099

NPI assigned

Feb 11, 2021

Sex

Male

Sole proprietor

No

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": "1613001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1316539299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7029 BENTRIDGE DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338134008",
            "telephone_number": "863-393-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 AVENUE K SE STE 1",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804148",
            "telephone_number": "863-293-5099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3875 S Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338131109",
            "country_code": "US",
            "telephone_number": "863-647-1515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROSBY",
        "first_name": "BLAKE",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-11",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN26120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sharon Crowfield-Bienaime
• Dorcas A Crumbley, B.A., CNA, HHA
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• Jose Gilberto Cruz, D.D.S.
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• Periodontics in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.