Alicia Nicole Blakley, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7031-15 Issued in WI

Practice address

8200 W Silver Spring Dr
Milwaukee, WI 53218-2552

Phone

(414) 760-3900

Fax

(414) 464-7258

NPI assigned

Aug 10, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Milwaukee Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
  • NPI 1518005818

  WI

  Medicare reassignment NPD
• Milwaukee Health Services Inc

  • Case Management Agency
  • Milwaukee, WI
  • NPI 1346657442
  NPD
• The Dental Clinic, LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1538330527

  General Practice

  NPD (past)

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1609155498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W ERIE ST",
            "address_2": "STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546914",
            "telephone_number": "920-838-1649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 W SILVER SPRING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532182552",
            "telephone_number": "414-760-3900",
            "fax_number": "414-464-7258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3210 W 63rd St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606293325",
            "country_code": "US",
            "telephone_number": "773-776-8300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2555 N Dr Martin Luther King Jr Dr",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532122709",
            "country_code": "US",
            "telephone_number": "414-372-8200",
            "fax_number": "414-562-8432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKLEY",
        "first_name": "ALICIA",
        "middle_name": "NICOLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-10",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "7031-15",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "7031-15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100029377",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Francillya Blake
• Mark Francis Blake, M.D.
• Melinda A Blake, APSW
• Sharita Blakemore
• Olyver Jarrett Blakeway, LCSW
• Cecilia Carmen Blancas, LCSW
• Mattison Blanck
• Lela Bland, APNP
• Ellen L Blank, MD
• Jacqueline Blank, MD

• All providers in Milwaukee, WI
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.