Thomas Joel Blake, D.D.S., M.S.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010588 Issued in WA

Practice address

721 N Pines Rd
Suite 101
Spokane Valley, WA 99206-5225

Phone

(509) 926-1234

Fax

(509) 926-1701

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1992862593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 N PINES RD",
            "address_2": "SUITE 101",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992065225",
            "telephone_number": "509-926-1234",
            "fax_number": "509-926-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 N PINES RD",
            "address_2": "SUITE 101",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992065225",
            "telephone_number": "509-926-1234",
            "fax_number": "509-926-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "THOMAS",
        "middle_name": "JOEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010588",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "5226914-9921",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5775",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5051255",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elissa Michelle Black, PA-C
• Nicole Black
• Douglas John Blackburn, ATC
• Katiejo Elizabeth Blaisdell
• Ryan Blake, D.M.D.
• Amy Blakeslee
• Ali Kae Blanchette
• Katherine Blanchette, MOTR/L
• Samantha M Blankenburg, OT
• Abigail Blankenship

• General Practice Dentistry in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; 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.