IndividualActive
Blake Brog, D.M.D.
NPI 1871624403 · Orthodontics and Dentofacial Orthopedics Dentistry · Bountiful, UT
Provider details
- NPI number
- 1871624403
- Entity type
- Individual
- Primary specialty
- Orthodontics and Dentofacial Orthopedics DentistryDental Providers
- Credential
- D.M.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 142188-9921 (UT)
Specialties & taxonomies
Dental Providers
Practice location
469 Medical Dr
Bountiful, UT 84010-4900
Phone: (801) 292-1888
Approximate (ZIP-level) locationGet directions
Mailing address
469 Medical Dr
Bountiful, UT 84010-4900
Registry dates
- Enumerated
- 2007-03-07
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.