Terry Michael Blake, DDS, MSD Valid NPI
Individual provider · Orthodontics and Dentofacial Orthopedics Dentistry · O'Fallon, MO
- NPI
- 1003485624
- Type
- Individual (Type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223X0400X
- License number
- 011574 (MO)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2021-06-18
- Last updated
- 2021-06-18
Practice location
225 South Main, Suite 101
O'Fallon, MO 63366
(636) 272-6666