Individual
DR. JOHN DAVID 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
Mailing address
1916 ELLIS AVE, CALDWELL, ID 83605-4811
(208) 459-2376
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-1741
ID
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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