Individual
KELLY JOHN BLODGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
522 SE BELMONT ST, PORTLAND, OR 97214
(503) 285-3620
(503) 735-9015
Mailing address
522 SE BELMONT ST, PORTLAND, OR 97214
(503) 285-3620
(503) 735-9015
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7669
OR
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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