Individual
DR. BLAKE N BROG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
469 MEDICAL DR, BOUNTIFUL, UT 84010-4900
(801) 292-1888
Mailing address
469 MEDICAL DR, BOUNTIFUL, UT 84010-4900
(801) 292-1888
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
142188-9921
UT
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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