Alan Max Blake

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

06008 Issued in IA

Practice address

808 N 9TH St
Estherville, IA 51334-1534

Phone

(712) 362-5454

Fax

(712) 362-4737

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Alan M. Blake D.D.S.

  • General Practice Dentistry
  • Estherville, IA
  • NPI 1558694117
  NPD (past) Authorized official
• Courtney S. Meyer, D.D.S., L.L.C.

  • General Practice Dentistry
  • Estherville, IA
  • NPI 1285055350
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831243013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 N 9TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341534",
            "telephone_number": "712-362-5454",
            "fax_number": "712-362-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 N 9TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341534",
            "telephone_number": "712-362-5454",
            "fax_number": "712-362-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ALAN",
        "middle_name": "MAX",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "06008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "06008",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0052308",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Avera Holy Family
• Avera Home Medical Equipment, LLC
• Nicole Backhaus, RPH
• Merle Craig Baker, O.D.
• Christine Marie Bauermeister, M.S., R.D., L.D.
• Krystine Kay Brashear, ARNP
• Dennis Don Bruns, DDS
• Katie Marie Carter, D.C.
• Champion State of Mind PLLC
• Anthony Ferillo Cook, M.D.

• General Practice Dentistry in Estherville, IA
• Providers in Estherville, IA by specialty
• General Practice Dentistry in Iowa

• 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.