NPI 1235713140 · live from the CMS NPI Registry
Blake Kevin Anderson, DMD
Dentist in Grants Pass, OR. National Provider Identifier 1235713140, active.
NPI record
| NPI | 1235713140 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 828 Ne A St, Grants Pass, OR 97526 |
| Practice phone | 916-765-7036 |
| Mailing address | 4674 E Foxwood Dr, Eagle Mountain, UT 84005 |
| Enumerated | May 6, 2021 |
| Last updated | May 6, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | D11424 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.