Provider Demographics
NPI:1013040237
Name:BLUTH, OSCAR DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:DANIEL
Last Name:BLUTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:O.
Other - Middle Name:DANIEL
Other - Last Name:BLUTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:521 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1404
Mailing Address - Country:US
Mailing Address - Phone:801-492-4666
Mailing Address - Fax:
Practice Address - Street 1:515 S 1000 E
Practice Address - Street 2:SUITE L-2 WEST
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3003
Practice Address - Country:US
Practice Address - Phone:801-370-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1333161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery