Clinton Larry Blake, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6330 Issued in OK

Practice address

831 Siena Springs Dr.
Norman, OK 73071

Phone

(405) 392-4883

Fax

(405) 392-4889

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1649328782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 NW 32ND ST",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656576",
            "telephone_number": "405-392-4883",
            "fax_number": "405-392-4889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 SIENA SPRINGS DR.",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "73071",
            "telephone_number": "405-392-4883",
            "fax_number": "405-392-4889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CLINTON",
        "middle_name": "LARRY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "4950075-9922",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Maxine Blackwell, LPC
• Terra Jo Blackwell, MA, LMFT
• Jean Renee Blackwood, M.A., LMFT CANDIDATE
• Martha Blaess, M.A., CF-SLP
• Amanda Blake
• Donisha Blakely
• Kailee Blakeway
• Darrell L Blakley
• Kimberly C Blakley, SLP-INTERN
• Kimberly R Blakley

• General Practice Dentistry in Norman, OK
• Providers in Norman, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.