Provider Demographics
NPI:1720122948
Name:PARRY, BLAKE G (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:G
Last Name:PARRY
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 1:2217 E ALOE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-2772
Mailing Address - Country:US
Mailing Address - Phone:480-726-1961
Mailing Address - Fax:520-836-2666
Practice Address - Street 1:992 E COTTONWOOD LN STE 106
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2219
Practice Address - Country:US
Practice Address - Phone:520-836-2600
Practice Address - Fax:520-836-2666
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist