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Organization

BLAISDELL DENTAL CENTER, PA

Active
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Organization

BLAISDELL DENTAL CENTER, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN D BLAISDELL DDS (PRESIDENT)
(208) 459-2376
Entity
Organization

Contact information

Practice address
1916 ELLIS AVE, CALDWELL, ID 83605-4811
(208) 459-2376
(208) 459-1524
Mailing address
1916 ELLIS AVE, CALDWELL, ID 83605-4811
(208) 459-2376
(208) 459-1524

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—

Other

Enumeration date
07/09/2008
Last updated
07/09/2008
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