Healthcare Provider Details

I. General information

NPI: 1356073621
Provider Name (Legal Business Name): COLE MATTHEW BLODGETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13927 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-5486
US

IV. Provider business mailing address

2800 4TH ST SW STE 1
MASON CITY IA
50401-1596
US

V. Phone/Fax

Practice location:
  • Phone: 904-507-7280
  • Fax:
Mailing address:
  • Phone: 262-825-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10010
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: