Livingston, Blake Gabriel

Livingston, Blake Gabriel is an individual health care provider with primary practice located at 13724 Woodward Ave , Highland Park MI 48203-3625. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Livingston, Blake Gabriel can be contacted via phone (313) 883-3050.

Contact Information

Primary practice address
13724 Woodward Ave Highland Park MI 48203-3625
Phone: (313) 883-3050
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 20372 Michigan
Dental Providers / General Practice 1223G0001X 20372 Michigan

Profile Details

NPI number 1750677902
LBN Legal business name Livingston, Blake Gabriel
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2011
Last updated May 15th, 2015 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750677902 NPPES
Michigan MEDICAID 1750677902

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