Healthcare Provider Details

I. General information

NPI: 1013040237
Provider Name (Legal Business Name): OSCAR DANIEL BLUTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: O. DANIEL BLUTH DDS

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 1000 E SUITE L-2 WEST
SALT LAKE CITY UT
84102-3003
US

IV. Provider business mailing address

521 WILDERNESS DR
ALPINE UT
84004-1404
US

V. Phone/Fax

Practice location:
  • Phone: 801-370-0050
  • Fax:
Mailing address:
  • Phone: 801-492-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number133316
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: