Individual
DR. MARK H BLAISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
625 E 500 S STE 203, BOUNTIFUL, UT 84010-3884
(801) 292-6819
(801) 298-8573
Mailing address
625 E 500 S STE 203, BOUNTIFUL, UT 84010-3884
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
140507-9922
UT
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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