Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Blaine Radley, DDS

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1902483670

Blaine Radley, DDS is a Student in an Organized Health Care Education/Training Program in Jacksonville, Florida. Practices as a sole proprietor and works from 2 locations. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

653 W 8th St
Jacksonville, FL 32209-6511
Phone: (904) 244-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3400 Spruce St, Philadelphia, PA 19104-4238 — (215) 316-5151

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1902483670
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedMarch 26, 2021
Last updated in NPPESMarch 31, 2022
Certification dateMarch 31, 2022
Mailing address653 W 8th St Fl 32209, Jacksonville, FL 32209-6511

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