Individual
DR. BLAKE KEVIN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
828 NE A ST, GRANTS PASS, OR 97526-2212
(916) 765-7036
Mailing address
4674 E FOXWOOD DR, EAGLE MOUNTAIN, UT 84005-6176
(916) 765-7036
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11424
OR
Other
Enumeration date
05/06/2021
Last updated
05/06/2021
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