Blake, Thomas R
Blake, Thomas R is an sole proprietor health care provider with primary practice located at 2409 Fairoak Dr , Fort Wayne IN 46809-2301. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Blake, Thomas R can be contacted via phone (260) 747-5745.Contact Information
Primary practice address
2409 Fairoak Dr
Fort Wayne IN 46809-2301
Phone: (260) 747-5745
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 7973 | Indiana |
Profile Details
| NPI number | 1669517330 |
|---|---|
| LBN Legal business name | Blake, Thomas R |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 21st, 2007 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669517330 | NPPES |
| Indiana | Other | 777279 | UNITED CONCORDIA |
| Indiana | Other | 1091 | UNITED CONCORDIA |
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