Provider Demographics
NPI:1295247674
Name:BLAKE DREW DMD, PC
Entity type:Organization
Organization Name:BLAKE DREW DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:971-226-6029
Mailing Address - Street 1:2323 NW HIGH LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7056
Mailing Address - Country:US
Mailing Address - Phone:971-226-6029
Mailing Address - Fax:541-279-2356
Practice Address - Street 1:2215 NW SHEVLIN PARK RD STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7195
Practice Address - Country:US
Practice Address - Phone:541-610-3270
Practice Address - Fax:541-279-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty