Richard Wayne Blake, DDS PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

0005634 Issued in FL

Practice address

2701 Park Dr
Suite #1
Clearwater, FL 33763-1021

Phone

(727) 796-2187

Fax

(727) 791-7660

NPI assigned

Jul 26, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1912921867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 PARK DR",
            "address_2": "SUITE #1",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631021",
            "telephone_number": "727-796-2187",
            "fax_number": "727-791-7660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 PARK DR",
            "address_2": "SUITE #1",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631021",
            "telephone_number": "727-796-2187",
            "fax_number": "727-791-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "RICHARD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "0005634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "074223600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmett Andrew Blahnik, DC
• Lakeisha Joyce Blair-Watson, M.D.
• Jayla Nicole Blair
• Nancy Carol Blair, CCC-SLP
• Linda Susanne Blake, LICSW
• Sonny James Blake, LMHC
• Joseph Antony Blanchette, LMHC
• Brie Blankenship, MA
• Reece Blankenship, PA-C
• Falon Blessing, DNP

• Pediatric Dentistry in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.