Richard W Blake DDS PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

0005634 Issued in FL

Legal business name

RICHARD W BLAKE DDS PA

Practice address

943 Cesery Blvd Ste D
Jacksonville, FL 32211-5655

Phone

(904) 743-2000

Fax

(904) 744-0598

NPI assigned

Jun 27, 2013

Last updated

Jun 27, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Richard Wayne Blake, DDS

Title

Owner/President

Phone

(904) 743-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372291200000",
    "number": "1558701177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 CESERY BLVD STE D",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115655",
            "telephone_number": "904-743-2000",
            "fax_number": "904-744-0598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 CESERY BLVD STE D",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115655",
            "telephone_number": "904-743-2000",
            "fax_number": "904-744-0598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD W BLAKE DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "19047432000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "0005634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "074223600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meshall D Rich
• Richard C. Mullens, DDS PLLC
• Richard E. Nay PHD Inc
• Richard G Wallis MD PA
• Richard M Blecha, M.D., LLC
• Alyssia Richard
• Dermon Richard Jr.
• Greggory Richard, PTT, DPT
• Anna Richards
• Arianna Richards, RBT

• Pediatric Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.