Individual
BLAINE A HAMMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
640 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 523-5400
(208) 528-0565
Mailing address
640 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 523-5400
(208) 528-0565
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4369
ID
Other
Enumeration date
06/23/2011
Last updated
06/23/2011
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