Provider Demographics
NPI:1841454683
Name:SHREEVE, BLAKE G (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:G
Last Name:SHREEVE
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 1:2500 S POWER RD
Mailing Address - Street 2:STE 131
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6686
Mailing Address - Country:US
Mailing Address - Phone:480-924-5577
Mailing Address - Fax:480-924-5573
Practice Address - Street 1:2500 S POWER RD
Practice Address - Street 2:STE 131
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6686
Practice Address - Country:US
Practice Address - Phone:480-924-5577
Practice Address - Fax:480-924-5573
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist