Provider Demographics
NPI:1316539299
Name:CROSBY, BLAKE ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ALEXANDER
Last Name:CROSBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7029 BENTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4008
Mailing Address - Country:US
Mailing Address - Phone:863-393-5167
Mailing Address - Fax:
Practice Address - Street 1:320 AVENUE K SE STE 1
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4148
Practice Address - Country:US
Practice Address - Phone:863-293-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN261201223P0300X
FL261201223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics