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General NPI Number Information
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NPI Number | 1881857753
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Entity Type | Organization
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Legal Business Name | BLAISDELL DENTAL CENTER, PA
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 1916 ELLIS AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4811
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Country | US
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Telephone | 208-459-2376
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Fax | 208-459-1524
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Provider Business Mailing Address
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Address Line | 1916 ELLIS AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4811
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Country | US
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Telephone | 208-459-2376
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Fax | 208-459-1524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN D BLAISDELL
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Credential | DDS
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Telephone | 208-459-2376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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