Provider Demographics
NPI:1427342096
Name:SETIEN, BLAKE B (DDS)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:B
Last Name:SETIEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 PERSHALL RD
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3075
Mailing Address - Country:US
Mailing Address - Phone:314-521-5678
Mailing Address - Fax:314-521-0283
Practice Address - Street 1:8430 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3075
Practice Address - Country:US
Practice Address - Phone:314-521-5678
Practice Address - Fax:314-521-0283
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist