Individual
DR. HEATH J. BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
198 S MAIN ST, PLEASANT GROVE, UT 84062-2631
(801) 785-8308
Mailing address
198 SOUTH MAIN STREET, PLEASANT GROVE, UT 84062
(801) 785-8308
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
5959068
UT
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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