Blake, Scott M

Blake, Scott M is an individual health care provider with primary practice located at 333 S Woodruff Ave , Idaho Falls ID 83401-4322. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Pathology, which is considered as his primary health care specialty. Blake, Scott M can be contacted via phone (208) 523-2160.

Contact Information

Primary practice address
333 S Woodruff Ave Idaho Falls ID 83401-4322
Phone: (208) 523-2160
Fax: (208) 552-8079
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Pathology 1223P0106X D3728 Idaho

Profile Details

NPI number 1376684175
LBN Legal business name Blake, Scott M
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 12th, 2007
Last updated Oct 15th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376684175 NPPES
Idaho Other 000010143970 REGENCE BLUE SHIELD
Idaho MEDICAID 118557800 REGENCE BLUE SHIELD
Idaho Other 1504752 REGENCE BLUE SHIELD
Idaho Other 6I468 REGENCE BLUE SHIELD
Idaho MEDICAID 806657300 REGENCE BLUE SHIELD
Idaho MEDICAID 806720800 REGENCE BLUE SHIELD

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