IndividualActive
Blake Boleware, DMD, MS
NPI 1881200673 · Orthodontics and Dentofacial Orthopedics Dentistry · Ridgeland, MS
Provider details
- NPI number
- 1881200673
- Entity type
- Individual
- Primary specialty
- Orthodontics and Dentofacial Orthopedics DentistryDental Providers
- Credential
- DMD, MS
- Sex
- Male
- Sole proprietor
- No
- License
- OR-575-20 (MS)
Practice location
525 Thomastown Ln Ste a
Ridgeland, MS 39157-3440
Phone: (601) 856-3054
Mailing address
525 Thomastown Ln Ste a
Ridgeland, MS 39157-3440
Registry dates
- Enumerated
- 2020-09-17
- Last updated
- 2023-08-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.