DR. SHANE CHRISTOPHER BLAKE D.M.D.
NPI 1023360609
Dentist in Coudersport, PA

Q: What is Shane Blake's NPI number?

The NPI number for Shane Blake is 1023360609. It was assigned to this individual provider in the NPPES registry on October 8, 2012.

Q: What is Shane Blake's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Blake was last updated on October 8, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 08, 2012PECOS Enrolled

507 DWIGHT ST, COUDERSPORT, PA 16915(814) 274-7262(800) 888-4760 Get Directions Write a Review

NPPES record last updated: October 8, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Shane Christopher Blake D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANE CHRISTOPHER BLAKE D.M.D. (NPI 1023360609) is an individual dentist in Coudersport, Pennsylvania, licensed in Pennsylvania (DS035521) and active in the NPI registry since October 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1023360609

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameDR. SHANE CHRISTOPHER BLAKECredential: D.M.D.

Location Address507 DWIGHT STCoudersport, PA 16915-1792

Mailing Address507 Dwight StCoudersport, PA 16915-1792 · (814) 274-7262 · Fax (800) 888-4760

Phone(814) 274-7262

Fax(800) 888-4760

Sole ProprietorYes

Enumeration DateOctober 8, 2012

✔ NPI 1023360609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in PA · DS035521

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

507 DWIGHT ST, Coudersport, PA 16915

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shane Christopher Blake D.m.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 16915 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.88 typical visit price

range $54.64 – $166.87

Typical copayment $21.22 (range $13.66 – $41.71)

Most-billed visit code 99203

Established Patient

$68.36 typical visit price

range $17.33 – $135.84

Typical copayment $17.09 (range $4.33 – $33.96)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BLAKE DENTISTRY, PC

Dentist (General Practice)

507 DWIGHT ST
COUDERSPORT, PA 16915

Potter County (814) 274-7262

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Blake's NPI number?

The NPI number for Shane Blake is 1023360609. It was assigned to this individual provider in the NPPES registry on October 8, 2012.

Where is Shane Blake located?

Shane Blake practices at 507 Dwight St, Coudersport, PA 16915. The listed phone number is (814) 274-7262.

What is Shane Blake's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Shane Blake enrolled in Medicare?

Yes. Shane Blake is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shane Blake was last updated on October 8, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.