Blake Hunter Weber, DDS
Individual provider Active NPI Dentist · LR, AR
NPI 1932276698 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1932276698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2866 (AR)
- Practice address
- 7924 Cantrell Rd
Suite B
LR, AR 72227-2501 - Phone
- (501) 225-0113
- Fax
- (501) 225-0155
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 2866 | AR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ethan Ake Dental PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2866 | AR | Yes |
Addresses
Primary practice location
7924 Cantrell Rd
Suite B
LR, AR 72227-2501
Mailing address
7924 Cantrell Rd
Suite B
LR, AR 72227-2501
Phone (501) 225-0113
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.