George Dale Blake Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8400 Issued in TX

Practice address

229 Half Moon Way
Runaway Bay, TX 76426-9773

Phone

(940) 575-4185

NPI assigned

May 30, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1117411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720081268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 HALF MOON WAY",
            "city": "RUNAWAY BAY",
            "state": "TX",
            "postal_code": "764269773",
            "telephone_number": "940-575-4185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 HALF MOON WAY",
            "city": "RUNAWAY BAY",
            "state": "TX",
            "postal_code": "764269773",
            "telephone_number": "940-575-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "GEORGE",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "8400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shady Oaks Clinic PLLC
• Yvette Young, PHARMACY TECHNICIAN

• General Practice Dentistry in Runaway Bay, TX
• Providers in Runaway Bay, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.