NPI 1003485624

Terry Michael Blake, DDSMSD

Practitioner Orthodontics and Dentofacial Orthopedics Dentistry O'Fallon, MO

Practice location

Address: 225 South Main Suite 101, O'Fallon, MO 63366
Phone: (636) 272-6666
Fax: (636) 272-6661

Registered specialties

Orthodontics and Dentofacial Orthopedics Dentistry Primary

Dental Providers Taxonomy 1223X0400X Licence 011574 (MO)

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Registry record

NPI: 1003485624
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Jun 2021
Record last updated: 18 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.