Scott M. Blake, DDS, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D3728 Issued in ID

Legal business name

SCOTT M. BLAKE, DDS, PC

Practice address

333 S Woodruff Ave
Idaho Falls, ID 83401-4322

Phone

(208) 523-2160

NPI assigned

Apr 30, 2008

Last updated

Apr 30, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elaine Schmidt

Title

Receptionist

Phone

(208) 523-2160

Specialties & licenses 1

Addresses

Other identifiers 7

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1972779916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014322",
            "telephone_number": "208-523-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014322",
            "telephone_number": "208-523-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT M. BLAKE, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "RECEPTIONIST",
        "authorized_official_telephone_number": "208-523-2160"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D3728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1504752",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806657300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806720800",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118557800",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "000010143970",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BXBS",
            "identifier": "6I468",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN BLUE CROSS",
            "identifier": "6M014",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James F Schmutz, MD
• Lyndsay Scholes
• Kayla Schroeder, M.S.
• Tim Robert Schuijt
• John Andrew Schulkins V, BS, IS
• Alisha Scott, PA-C
• Jared Stephan Scott, DC
• John Patrick Scott
• Kade Scott, DPT, CLT
• Lexie E Scott

• Oral and Maxillofacial Surgery (Dentist) in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.