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Organization
SCOTT M. BLAKE, DDS, PC
Active
Organization
SCOTT M. BLAKE, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE SCHMIDT (RECEPTIONIST)
(208) 523-2160
Entity
Organization
Contact information
Practice address
333 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4322
(208) 523-2160
Mailing address
333 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4322
(208) 523-2160
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D3728
ID
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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