Blake Edward Bandeff, DMD
Individual provider Active NPI General Practice Dentistry · Summit, NJ
NPI 1770046047 · NPPES record last updated Feb 4, 2026
Key facts
- NPI
- 1770046047
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 22DI02913800 (NJ)
- Practice address
- 33 Overlook Rd Ste 402
Summit, NJ 07901-3564 - Phone
- (908) 522-0077
- NPI assigned
- Apr 12, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| 22DI02913800 | NJ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kevin P. Dougherty, DMD, PA | General Practice | Past | Accepting new patients |
| Glen P Berkowitz DDS PA | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI02913800 | NJ | Yes |
Addresses
Primary practice location
33 Overlook Rd Ste 402
Summit, NJ 07901-3564
Mailing address
475 Shunpike Rd
Chatham, NJ 07928-1528
Phone (301) 991-6958
Other practice location 1
475 Shunpike Rd
Chatham, NJ 07928-1528
Phone (973) 377-3000
Other providers in Summit, NJ
- Khawaja Bakhtawar
- Nikhita Balabbigari
- Jaclyn Baldini
- Adrian Claudiu Balica
- Santina Bambaci
- Ashley Brooke Baranwal
- Sarah Barnett
- Nicholas Barone
- Jon Albert Bartlett
- Loucia Barton
All providers in Summit, NJ · General Practice Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2026. 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.