Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 133316 | UT |
NPI | 1013040237 |
---|---|
Provider Name | Dr. Oscar Daniel Bluth |
First Address | Alpine, UT 84004-1404 |
Second Address | Salt Lake City, UT 84102-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 16/06/2008 |