Dr. Terry Michael Blake
Orthodontists
225 South Main Suite 101
OFallon
, Missouri 63366
Dr. Terry Michael Blake
Orthodontists
225 South Main Suite 101
OFallon
, Missouri 63366
(636) 272-6661
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About
Features
Specialties
- Orthodontists
Languages spoken
- English
Location
First Address
- Dr. Terry Michael Blake
- 225 South Main Suite 101
- O'fallon, MO
- Zip : 63366
- Fax : (636) 272-6661
- Phone : (636) 272-6666
Second Address
- Dr. Terry Michael Blake
- 225 South Main Suite 101
- O'fallon, MO
- Zip : 63366
- Fax : (636) 272-6661
- Phone : (636) 272-6666
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223X0400X | Orthodontists | 011574 | MO |
National Provider Identifier
| NPI | 1003485624 |
|---|---|
| Provider Name | Dr. Terry Michael Blake |
| First Address | O'fallon, MO 63366 |
| Second Address | O'fallon, MO 63366 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/06/2021 |
| Last Update Date | 18/06/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.