Individual
CRAIG BLACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
Mailing address
333 W 350 S, VERNAL, UT 84078
(435) 789-7711
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
296101-9922
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700000000009
—
UT
Enumeration date
03/06/2007
Last updated
07/21/2022
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