IndividualActive
Scott Blake, DDS
NPI 1376684175 · Oral and Maxillofacial Pathology Dentistry · Idaho Falls, ID
Provider details
- NPI number
- 1376684175
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Pathology DentistryDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- License
- D3728 (ID)
Specialties & taxonomies
Dental Providers
Practice location
333 S Woodruff Ave
Idaho Falls, ID 83401-4322
Phone: (208) 523-2160
Fax: (208) 552-8079
Approximate (ZIP-level) locationGet directions
Mailing address
333 S Woodruff Ave
Idaho Falls, ID 83401-4322
Registry dates
- Enumerated
- 2007-02-12
- Last updated
- 2015-10-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.