Provider Demographics
NPI:1194949511
Name:DON BLAKESLEE DDS PA
Entity type:Organization
Organization Name:DON BLAKESLEE DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLAKESLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-784-1242
Mailing Address - Street 1:10155 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-8058
Mailing Address - Country:US
Mailing Address - Phone:763-784-1214
Mailing Address - Fax:
Practice Address - Street 1:10155 UNIVERSITY AVE NE
Practice Address - Street 2:STE 112
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-8058
Practice Address - Country:US
Practice Address - Phone:763-784-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty