Individual
BLAKE LYNN MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3610 N UNIVERSITY AVE, #200, PROVO, UT 84604-4437
(801) 377-9600
Mailing address
3540 NORTH 465 WEST, PROVO, UT 84601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
222754989922
UT
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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