Susan Elizabeth Blake, DMD
Individual provider Active NPI Dentist · Troy, VA
NPI 1669694253 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1669694253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401008275 (VA)
- Practice address
- Fluvanna Correctional Center
Route 250 East
Troy, VA 22974 - Phone
- (434) 984-3700
- Fax
- (434) 984-5574
- NPI assigned
- May 3, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 0401008275 | VA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401008275 | VA | Yes |
Addresses
Primary practice location
Fluvanna Correctional Center
Route 250 East
Troy, VA 22974
Mailing address
852 Jefferson Dr E
Palmyra, VA 22963-3302
Phone (434) 591-0168
Other providers in Troy, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.