Individual
BLAKE DAVID MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4651 W 13400 S STE 110, RIVERTON, UT 84096-6483
(801) 515-5858
Mailing address
11039 S RYAN PARK AVE, SANDY, UT 84092-5205
(425) 941-0314
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
11622565-9921
UT
Other
Enumeration date
04/03/2019
Last updated
02/08/2024
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