Individual
DR. R. BLAKE NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1434 E 4500 S, SUITE #201, SALT LAKE CITY, UT 84117-4250
(801) 272-5800
(801) 272-5897
Mailing address
1434 E 4500 S, SUITE #201, SALT LAKE CITY, UT 84117-4250
(801) 272-5800
(801) 272-5897
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
90-0144898-9922
UT
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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