Mark H. Blaisdell DDS, PC

Primary specialty

DentistTaxonomy code 122300000X

License

2009-37520 Issued in UT

Legal business name

MARK H. BLAISDELL DDS, PC

Practice address

625 E 500 S
Suite 203
Bountiful, UT 84010-3882

Phone

(801) 292-6819

Fax

(801) 298-8573

NPI assigned

Sep 23, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Harris Blaisdell, DDS

Title

President

Phone

(801) 292-6819

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyson Bishop, DMD

  • General Practice Dentistry
  • Bountiful, UT
  • NPI 1770111692
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253664000000",
    "number": "1184958159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E 500 S",
            "address_2": "SUITE 203",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840103882",
            "telephone_number": "801-292-6819",
            "fax_number": "801-298-8573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E 500 S",
            "address_2": "SUITE 203",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840103882",
            "telephone_number": "801-292-6819",
            "fax_number": "801-298-8573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK H. BLAISDELL DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-23",
        "last_updated": "2009-09-23",
        "status": "A",
        "authorized_official_last_name": "BLAISDELL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "HARRIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-292-6819",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "2009-37520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robyn Manning
• Jessica Mansell
• Elizabeth Mantanona
• Todd Reece Manwaring, MSW, LCSW
• Brianda Marin
• Marlin M Forsyth
• Khilali Marquez
• Christiana Loukia Martakou
• Martha a. Keil LCSW PC
• Kristin Kay Martin

• Dentist in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.