institution
Scott M. Blake, Dds, Pc
Oral and Maxillofacial Surgery (Dentist) in Idaho Falls, Idaho
NPI 1972779916

Scott M. Blake, Dds, Pc is a Oral and Maxillofacial Surgery (Dentist) based in Idaho Falls, ID and is specialized in Oral and Maxillofacial Surgery. Scott M. Blake, Dds, Pc practices in Idaho Falls, ID. The NPI Number for Scott M. Blake, Dds, Pc is 1972779916 and holds a License No. D3728 (Idaho).

The current practice location address for Scott M. Blake, Dds, Pc is 333 S Woodruff Ave, Idaho Falls, ID and can be reached out via phone at 208-523-2160.

Location: 333 S Woodruff Ave, Idaho Falls, ID, 83401-4322
institution
Provider Profile Details
NPI Number
1972779916
Provider Name
Scott M. Blake, Dds, Pc
Credential
Provider Entity Type
Organization
Address
333 S Woodruff Ave, Idaho Falls, ID, 83401-4322
Phone Number
208-523-2160
Fax Number
Provider Enumeration Date
04/30/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1504752 01 UNITED CONCORDIA
806657300 05 ID
806720800 05 ID
118557800 05 WY
000010143970 01 REGENCE BLUESHIELD
6I468 01 FEDERAL BXBS
6M014 01 UPIN BLUE CROSS
institution
Provider Business Practice Location Address Details
Address
333 S Woodruff Ave
City
State
Zip
83401-4322
Phone Number
208-523-2160
Fax Number
person
Provider Business Mailing Address Details
Address
333 S Woodruff Ave
City
State
Zip
83401-4322
Phone Number
208-523-2160
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
License No.
D3728 (Idaho)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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