MEDICARE: MR. BLAIR D TOMLINSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	145296	UT

General Provider Information

NPI Number	:	1952318024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAIR D TOMLINSON D.D.S.

Provider Business Mailing Address
First Line	:	360 S FORT LN STE 108
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4202
Country	:	US
Telephone Number	:	801-546-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 S FORT LN
Second Line	:	#108
City	:	LAYTON
State	:	UT
Zip	:	84041-4259
Country	:	US
Telephone Number	:	801-546-1066
Fax Number	:	801-546-1967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	11/24/2015

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