Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

BLAKE ANDREW MADDALENA DDS
NPI 1124954789
Dentist - General Practice in Detroit, MI

Q: What is Blake Maddalena's NPI number?

The NPI number for Blake Maddalena is 1124954789. It was assigned to this individual provider in the NPPES registry on June 22, 2026.

Q: What is Blake Maddalena's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Blake Maddalena was last updated on June 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 52 days 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 June 22, 2026

4646 JOHN R ST, DETROIT, MI 48201(313) 576-1000 Get Directions Write a Review

NPPES record added: June 22, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Blake Andrew Maddalena Dds NPPES

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

BLAKE ANDREW MADDALENA DDS (NPI 1124954789) is an individual general practice provider in Detroit, Michigan, licensed in Michigan (2901603171) and active in the NPI registry since June 2026.

NPPES Registry Identity

NPI1124954789

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameBLAKE ANDREW MADDALENACredential: DDS

Location Address4646 JOHN R STDetroit, MI 48201-1916

Mailing Address4646 John R StDetroit, MI 48201-1916 · (313) 576-1000

Phone(313) 576-1000

Sole ProprietorNo

Enumeration DateJune 22, 2026

NPPES CertifiedJune 22, 2026

✔ NPI 1124954789 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in MI · 2901603171

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

4646 JOHN R ST, Detroit, MI 48201

Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

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

DR. YURIJ CHERSTYLO

Student in an Organized Health Care Education/Training Program