Christopher Allen Blake, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5002097015 Issued in WI

Practice address

17280 W North Ave
Suite 102
Brookfield, WI 53045-4366

Phone

(262) 789-9200

Fax

(262) 789-9213

NPI assigned

Oct 27, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 20, 2015 through May 20, 2027

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.

• Dr Christopher Blake SC

  • Dentist
  • Brookfield, WI
  • NPI 1386783488
  NPD (past) Authorized official

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1831499532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17280 W NORTH AVE",
            "address_2": "SUITE 102",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454366",
            "telephone_number": "262-789-9200",
            "fax_number": "262-789-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17280 W NORTH AVE",
            "address_2": "SUITE 102",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454366",
            "telephone_number": "262-789-9200",
            "fax_number": "262-789-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CHRISTOPHER",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5002097015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BKD Brookdale Place of Brookfield, LLC
• BKD Clare Bridge Place Brookfield, LLC
• Stuart E Blacher, MD
• Aubrey Blahnik, MS, CCC-SLP
• Ryan R. Blair
• Sara Blandino, LMT
• Russell Blankenburg, MD
• Bryanne Lee Blanton, BCBA, LBA, MS
• Gregory Michael Blau, D.C.
• Dean Thomas Blazek, D.C.

• All providers in Brookfield, WI
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.