SCOTT M BLAKE (NPI# 1376684175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376684175 |
| Entity Type | Individual |
| Full Name | SCOTT M BLAKE |
| Credential | DDS |
| Practice Address |
333 S Woodruff Ave Idaho Falls ID 83401-4322 |
| Practice Telephone | 2085232160 |
| Practice Fax Number | 2085528079 |
| Mailing Telephone | 2085232160 |
| Mailing Fax Number | 2085528079 |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2015-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
D3728 | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | REGENCE BLUE SHIELD | 000010143970 | 01 |
| ID | 806657300 | 05 | |
| ID | FEDERAL BLUE CROSS | 6I468 | 01 |
| WY | 118557800 | 05 | |
| ID | UNITED CONCORDIA | 1504752 | 01 |
| ID | 806720800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700318987 | Scott Patrick Blake | Student in an Organized Health Care Education/Training Program | 1711 N 6th 1/2 St Ste 100, Terre Haute, IN 47804-2700 | 2017-03-28 |
| Street Address |
333 S WOODRUFF AVE |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83401-4322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609977891 | John Owen | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2006-09-26 |
| 1235565003 | Kevin Mudrow Dds Pllc | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2013-09-24 |
| 1194097402 | Russell Guymon Orthodontics, Pa | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2012-02-01 |
| 1295995652 | Vernon O. Gaffner, D.m.d., P.a. | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2008-06-10 |
| 1093981011 | Owen Dental, PC | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2008-04-30 |
| 1972779916 | Scott M. Blake, Dds, PC | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2008-04-30 |
| 1114126992 | Kevin Richard Mudrow | Dentist | 333 S Woodruff Ave, Suite F, Idaho Falls, ID 83401-4322 | 2007-07-12 |
| 1821130253 | Jeffrey W Johnson | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2007-02-13 |
| 1376627802 | Vernon O Gaffner | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454796 | Natalie M Theriault | Acupuncturist | 864 S Holmes, Idaho Falls, ID 83401 | 2020-10-09 |
| 1366099293 | Idaho Recovery Center, LLC. | Counselor | 771 South Woodruff Avenue, Idaho Falls, ID 83401 | 2019-08-26 |
| 1851859110 | Rebecca Chidester | Counselor | 771 Parkwood St., Idaho Falls, ID 83401 | 2019-03-06 |
| 1467924985 | Benchmark Home Health | Registered Nurse | 2098 Gladys Dr., Idaho Falls, ID 83401 | 2018-12-21 |
| 1134625338 | Idaho Falls Hand Therapy Limited Partnership | Clinic/Center | 564 S Woodruff Avenue, Idaho Falls, ID 83401 | 2018-04-05 |
| 1992227367 | Brenda Emery | Rehabilitation Practitioner | 540 3rd Street, Idaho Falls, ID 83401 | 2017-07-07 |
| 1689068454 | Addiction Treatment Centers of Idaho | Community/Behavioral Health | 211 S. Woodruff Avenue, Idaho Falls, ID 83401 | 2015-03-19 |
| 1386986412 | Jennifer Lee Henderson | Psychologist | 111 E. 16th Street, Innovative Health Care Concepts Inc., Idaho Falls, ID 83401 | 2013-03-27 |
| 1487994430 | Sterling Physician Group Pllc | Clinic/Center | 740 S. Woodruff Ave, Idaho Falls, ID 83401 | 2013-02-27 |
| 1952638025 | Allstar Counseling Inc. | Case Management | 550 2nd Street, Suite 269, Idaho Falls, ID 83401 | 2009-11-11 |
| Find all providers in zip 83401 | ||||
| Taxonomy Code | 1223P0106X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Pathology |
| The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114957917 | Nicholas A Massoth | Dentist | 4121 Clock Tower Ave, Caldwell, ID 83607-5006 | 2006-07-04 |
| 1376593640 | Eric Webb Nelson | Dentist | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2006-05-10 |
| 1568095883 | Facial Trauma Associates Pllc | Dentist | 1000 N Curtis Rd Ste 103, Boise, ID 83706-1345 | 2020-02-14 |
| 1710184783 | Canyon County Oral Maxillofacial Surgery, Inc | Dentist | 4121 Clock Tower Ave, Caldwell, ID 83607-5006 | 2007-07-02 |
| 1588868442 | Idaho Oral & Maxillofacial Surgery, PC | Dentist | 590 Falls Ave, Twin Falls, ID 83301-3314 | 2007-06-13 |
| City | IDAHO FALLS |
| Zip Code | 83401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.