| Scott M. Blake, Dds, Pc | |
|
333 S Woodruff Ave Idaho Falls ID 83401-4322 | |
| (208) 523-2160 | |
| Not Available |
| Full Name | Scott M. Blake, Dds, Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 333 S Woodruff Ave, Idaho Falls, Idaho |
| Authorized Official Name and Position | Elaine Schmidt (RECEPTIONIST) |
| Authorized Official Contact | 2085232160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott M. Blake, Dds, Pc 333 S Woodruff Ave Idaho Falls ID 83401-4322 Ph: (208) 523-2160 | Scott M. Blake, Dds, Pc 333 S Woodruff Ave Idaho Falls ID 83401-4322 Ph: (208) 523-2160 |
| NPI Number | 1972779916 |
|---|---|
| Provider Enumeration Date | 04/30/2008 |
| Last Update Date | 04/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972779916 | NPI | - | NPPES |
| 1504752 | Other | UNITED CONCORDIA | |
| 806657300 | Medicaid | ID | |
| 806720800 | Medicaid | ID | |
| 118557800 | Medicaid | WY | |
| 000010143970 | Other | REGENCE BLUESHIELD | |
| 6I468 | Other | FEDERAL BXBS | |
| 6M014 | Other | UPIN BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D3728 (Idaho) | Primary |
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