Summer Lynn Blake, D.D.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Manhattan Beach, CA
NPI 1578896445 · NPPES record last updated Mar 24, 2010
Key facts
- NPI
- 1578896445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 48703 (CA)
- Practice address
- 451 Manhattan Beach Blvd
Suite #D-224
Manhattan Beach, CA 90266-5345 - Phone
- (310) 545-0770
- NPI assigned
- Sep 10, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 48703 | CA | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 48703 | CA | Yes |
Addresses
Primary practice location
451 Manhattan Beach Blvd
Suite #D-224
Manhattan Beach, CA 90266-5345
Mailing address
451 Manhattan Beach Blvd
Suite #D-224
Manhattan Beach, CA 90266-5345
Phone (310) 545-0770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1223X0400X | Other | CA | ORTHODONTIC NPI |
Other providers in Manhattan Beach, CA
- Joy Bhat
- Diego Andres Bignone
- Birznieks Chiropractic, Inc.
- David Birznieks
- Blake Watts
- Yifat Block
- Peter James Bloomfield
- Body in Balance Health Center and Spa
- Viviana Bonansea
- Tina Leanne Bourdeaud'Hui
All providers in Manhattan Beach, CA · Orthodontics and Dentofacial Orthopedics Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2010. 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.