DR. ROBERT EDWARD BLAKE (NPI# 1407864440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407864440 |
| Entity Type | Individual |
| Full Name | DR. ROBERT EDWARD BLAKE |
| Credential | D.D.S.,M.S. |
| Practice Address |
104 N Park Dr Fayetteville GA 30214-1645 |
| Practice Telephone | 7704619931 |
| Practice Fax Number | 7704619176 |
| Mailing Telephone | 7704619931 |
| Mailing Fax Number | 7704619176 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
7991 | GA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245756170 | Robert G Blake | Physical Therapist | 10004 Nw 54th Pl, Coral Springs, FL 33076-2420 | 2017-08-22 |
| 1285029389 | Robert Demarest Blake Jr. | Licensed Practical Nurse | 11242 Mills Mills Rd, Fillmore, NY 14735-8622 | 2015-04-06 |
| 1104262930 | Robert Alexander Blake | Student in an Organized Health Care Education/Training Program | 1255 Nuuanu Ave, 1309, Honolulu, HI 96817-4017 | 2013-05-20 |
| 1760707061 | Robert Mcgowin Blake | Massage Therapist | 643 First Street North, Alabaster, AL 35007 | 2010-03-30 |
| 1972794212 | Robert E Blake | Counselor | 3969 4th Ave Ste 203, San Diego, CA 92103-3165 | 2007-08-01 |
| 1891850558 | Robert Quincy Blake | Social Worker | 1204 Paul Dr, Cedar Hill, TX 75104-6216 | 2006-12-23 |
| 1356442446 | Robert A Blake | Dentist | 50 West St, Beverly, MA 01915-2228 | 2006-09-25 |
| 1942283213 | Robert Allen Blake | Pharmacist | 206 N Market St, West Union, OH 45693-1307 | 2005-11-21 |
| 1285635904 | Robert B Blake | Orthopaedic Surgery | 1450 Ellis St, Suite 201, Bozeman, MT 59715-8812 | 2005-08-03 |
| 1174978191 | Robert Philp Blake | Counselor | 603 Hemlock St, Suite 2b, Brookings, OR 97415 | 2016-04-27 |
| Street Address |
104 N PARK DR |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578001616 | Jesse R Gray Dds Pa | Dentist | 3119 E Mission Blvd, Fayetteville, AR 72703-6617 | 2017-02-09 |
| 1972972685 | Trinity Orthodontics of Fayetteville LLC | Dentist | 719 Lanier Ave W Ste B, Fayetteville, GA 30214-7621 | 2015-09-23 |
| 1386048189 | Bethel Burris Oliver Pllc | Dentist | 2901 Zion Rd, Fayetteville, AR 72703-5007 | 2014-10-22 |
| 1083957351 | Gateway Ventures LLC | Dentist | 3782 N Front St, Suite 1, Fayetteville, AR 72703-5128 | 2013-04-04 |
| 1780995449 | Gregory J Stock | Dentist | 404 E Genesee St, Fayetteville, NY 13066-1503 | 2010-06-28 |
| 1003019845 | Dana Thi Tang | Dentist | 2997 Hope Mills Rd Ste C, Fayetteville, NC 28306-8349 | 2007-06-08 |
| 1326256066 | Eric J. Echols | Dentist | 102 Pavilion Pkwy, Suite 14, Fayetteville, GA 30214-4056 | 2007-05-18 |
| 1033325436 | Darrin Storms D.d.s., C.a.g.s., P.a. | Dentist | 4102 N Mall Ave Ste 101, Fayetteville, AR 72703-4929 | 2007-05-15 |
| 1962623819 | J. Spencer Boley | Dentist | 4501 W Wedge Dr, Fayetteville, AR 72704-7532 | 2007-05-01 |
| 1992864375 | Michael W Granger | Dentist | 745 Bradley Dr, Fayetteville, GA 30214-2030 | 2006-12-08 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.