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BLAKE DENTISTRY, PC
NPI 1962567644
Dentist - General Practice in Coudersport, PA

Active since December 24, 2006
507 DWIGHT ST, COUDERSPORT, PA 16915(814) 274-7262(814) 274-0879 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Blake Dentistry, Pc NPPES

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

BLAKE DENTISTRY, PC (NPI 1962567644) is a healthcare organization registered as a general practice in Coudersport, Pennsylvania and active in the NPI registry since December 2006. The organization lists Shane Christopher Blake, President, as its authorized official.

NPPES Registry Identity

NPI1962567644
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameBLAKE DENTISTRY, PC
Location Address507 DWIGHT STCoudersport, PA 16915-1792
Mailing Address507 Dwight StCoudersport, PA 16915-1792 · (814) 274-7262 · Fax (814) 274-0879
Phone(814) 274-7262
Fax(814) 274-0879
Organization SubpartNo
Authorized OfficialShane Christopher BlakePresident · (814) 274-7262
Enumeration DateDecember 24, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1962567644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in PA · DS-035521
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.
507 DWIGHT ST, Coudersport, PA 16915
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Other Identifiers 1

Medicaid0019285420002PA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

DR. SHANE CHRISTOPHER BLAKE D.M.D.
Dentist
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 Blake Dentistry, PC's NPI number?

The NPI number for Blake Dentistry, PC is 1962567644. It was assigned to this organization in the NPPES registry on December 24, 2006.

Where is Blake Dentistry, PC located?

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

What is Blake Dentistry, PC's specialty?

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

When was this NPI record last updated?

The NPPES record for Blake Dentistry, PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.