Individual
MR. BLAKE CARDON PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3377 W LAZY J LN, LEHI, UT 84043-6337
(480) 273-4544
Mailing address
3377 W LAZY J LN, LEHI, UT 84043-6337
(480) 273-4544
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7821520-9925
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D-5568-OS
ID
390200000X
Student in an Organized Health Care Education/Training Program
RES-30526
IA
Other
Enumeration date
02/15/2018
Last updated
12/08/2023
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