Provider Demographics
NPI:1568632990
Name:BLAKE, ROY C III (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:C
Last Name:BLAKE
Suffix:III
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 BUTLER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6036
Mailing Address - Country:US
Mailing Address - Phone:561-296-3399
Mailing Address - Fax:561-202-6776
Practice Address - Street 1:200 BUTLER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6036
Practice Address - Country:US
Practice Address - Phone:561-296-3399
Practice Address - Fax:561-202-6776
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN95511223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics