| Mark H. Blaisdell DDS, PC | |
|
625 E 500 S Suite 203 Bountiful UT 84010-3882 | |
| (801) 292-6819 | |
| (801) 298-8573 |
| Full Name | Mark H. Blaisdell DDS, PC |
|---|---|
| Speciality | Dentist |
| Location | 625 E 500 S, Bountiful, Utah |
| Authorized Official Name and Position | Mark Harris Blaisdell (PRESIDENT) |
| Authorized Official Contact | 8012926819 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark H. Blaisdell DDS, PC 625 E 500 S Suite 203 Bountiful UT 84010-3882 Ph: (801) 292-6819 | Mark H. Blaisdell DDS, PC 625 E 500 S Suite 203 Bountiful UT 84010-3882 Ph: (801) 292-6819 |
| NPI Number | 1184958159 |
|---|---|
| Provider Enumeration Date | 09/23/2009 |
| Last Update Date | 09/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184958159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2009-37520 (Utah) | Primary |
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