| NPI | 1093932881 |
|---|---|
| Doing Business As | BLAKE STREET DENTAL PC |
| Entity Type | Organization |
| Authorized Contact | ARNOLD BRADLEY CULLUM CEO President 719-591-2004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |