Provider Demographics
NPI:1407647902
Name:BLAKE, ANIA JAMIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANIA
Middle Name:JAMIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 CLIFTON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1147
Mailing Address - Country:US
Mailing Address - Phone:301-802-9178
Mailing Address - Fax:
Practice Address - Street 1:17625 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1999
Practice Address - Country:US
Practice Address - Phone:313-554-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program