DR. RYAN BLAKE (NPI# 1861841918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861841918 |
| Entity Type | Individual |
| Full Name | DR. RYAN BLAKE |
| Credential | D.M.D. |
| Practice Address |
4425 S. Mountain Road Ste 109 Mesa AZ 85212 |
| Mailing Address |
4850 S Eastern Run Mesa AZ 85212-8070 |
| Practice Telephone | 4806761517 |
| Mailing Telephone | 4356697308 |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2018-10-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
10161 | AZ | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
60796314 | WA | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982233979 | Ryan Blake | Student in an Organized Health Care Education/Training Program | 1468 Madison Ave, New York, NY 10029-6508 | 2020-04-02 |
| 1265083208 | Ryan Blake | Family Medicine | 3752 W 16th St, Chicago, IL 60623-2028 | 2019-09-20 |
| Street Address |
4425 S. MOUNTAIN ROAD STE 109 |
| City | MESA |
| State | AZ |
| Zip Code | 85212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922610302 | West Point Optical Group | Optometrist | 10706 E Point Twenty-two Blvd, #107, Mesa, AZ 85212 | 2020-08-18 |
| 1215553565 | Andrew Eugene Pak | Dentist | 10664 East Point Twenty-two Blvd, Mesa, AZ 85212 | 2020-06-23 |
| 1588200265 | Signal Butte Kids Dentistry and Orthodontics, LLP | Dentist | 10664 E. Point Twenty Two Blvd, Mesa, AZ 85212 | 2019-11-18 |
| 1194371526 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 4316 S Signal Butte Rd, Mesa, AZ 85212 | 2019-08-12 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1033623541 | Latanya Olivia Edenburgs | Case Manager/Care Coordinator | 10436 E Radiant Ave., Mesa, AZ 85212 | 2017-11-20 |
| 1205355880 | Linda Okafor | Nurse Practitioner | 4719 S Calderon Circle, Mesa, AZ 85212 | 2017-09-14 |
| 1689121188 | Agh Mesa LLC | General Acute Care Hospital | 9130 East Elliot Road, Mesa, AZ 85212 | 2016-09-01 |
| 1083089460 | White Glove Health | Nurse Practitioner | 2906 S Lynch Cr, Mesa, AZ 85212 | 2015-12-10 |
| 1750768446 | Beth Furman, Do, LLC | Clinic/Center | 3035 S Ellsworth, Suite #103, Mesa, AZ 85212 | 2015-05-01 |
| Find all providers in zip 85212 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033750724 | Mesa Valley Dental LLC | Dentist | 1220 S Higley Rd Ste 206, Mesa, AZ 85206-4002 | 2019-10-03 |
| 1942841663 | Mesa Kidtastic Dental LLC | Dentist | 1240 W Southern Ave Ste 112, Mesa, AZ 85202-4882 | 2019-10-03 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1407344567 | Kids Dental Group Pllc | Dentist | 6239 E Brown Rd Ste 102, Mesa, AZ 85205-4933 | 2018-04-24 |
| 1215281688 | Fiesta Kidtastic, LLC | Dentist | 1303 S Longmore Ste 1, Mesa, AZ 85202-9607 | 2012-11-06 |
| 1770831430 | Brian Glen Banks | Dentist | 2500 S Power Rd Ste 128, Mesa, AZ 85209 | 2012-08-28 |
| 1477811842 | Kids Dental Specialists LLC | Dentist | 1305 S Alma School Rd, Mesa, AZ 85210-2070 | 2012-04-24 |
| 1508178898 | John William Taylor | Dentist | 4540 E. Baseline Rd, Suite 102, Mesa, AZ 85206 | 2010-07-02 |
| 1245411644 | John W. Taylor, Dds, Pllc | Dentist | 4540 E Baseline Rd., Ste. 102, Mesa, AZ 85206 | 2007-11-14 |
| 1245450469 | Cory Giles | Dentist | 1635 N Greenfield Rd Ste 111, Mesa, AZ 85205-4010 | 2007-04-27 |
| Find all providers in MESA | ||||
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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.