Basic Information
| Provider Information | |||||||||
| NPI: | 1619973633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAKEY | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 SERRANO WAY | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275178545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199680021 | ||||||||
| FaxNumber: | 9199666019 | ||||||||
| Practice Location | |||||||||
| Address1: | UNC ORAL AND MAXILLOFACIAL SURGERY | ||||||||
| Address2: | 115 BRAUER HALL, CB #7450 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661126 | ||||||||
| FaxNumber: | 9199666019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 6205 | NC | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.