Organization · NPI-2

Blake Ferando Dmd LLC

Dentist, General Practice · O Fallon, MO

NPI number1750868915
StatusActive
Last updated in NPPESJul 20, 2018

Details

NPI
1750868915
Entity type
Organization (NPI-2)
Legal business name
Blake Ferando Dmd LLC
Organization subpart
No
Enumeration date
Jul 20, 2018
Last updated
Jul 20, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice2018015357MOYes

Practice location

346 Fort Zumwalt Sq
O Fallon, MO 63366-3065

Phone 636-978-6400

Mailing address

346 Fort Zumwalt Sq
O Fallon, MO 63366-3065

Phone 636-978-6400

Authorized official

Blake Anthony Ferando
Doctor
6369786400

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