Individual
DR. MICHAEL BLACKHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1963 S 1200 E STE 103, SALT LAKE CITY, UT 84105-3523
(801) 466-1212
Mailing address
1963 S 1200 E STE 103, SALT LAKE CITY, UT 84105-3523
(801) 466-1212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9836551-9922
UT
Other
Enumeration date
06/29/2016
Last updated
06/29/2016
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