Basic Information
| Provider Information | |||||||||
| NPI: | 1699288084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | BLAKE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 HAMILTON AVE | ||||||||
| Address2: | |||||||||
| City: | GLEN ROCK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074522203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014526995 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1775 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104538202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185901800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2017 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 22DI02695000 | NJ | Y | Dental Providers | Dentist |
No ID Information.