Individual
THOMAS LAGRAND BLAISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1916 ELLIS AVE, CALDWELL, ID 83605-4811
(208) 459-2376
(208) 459-1524
Mailing address
416 LARKSPUR CT, CALDWELL, ID 83605-6294
(208) 402-4302
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4079
ID
Other
Enumeration date
06/28/2007
Last updated
07/08/2007
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