Provider Demographics
NPI:1073775581
Name:DAYLEY, BLAKE ISAAC (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ISAAC
Last Name:DAYLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 S TIMESQUARE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8266
Mailing Address - Country:US
Mailing Address - Phone:208-321-1141
Mailing Address - Fax:208-321-1143
Practice Address - Street 1:1578 S TIMESQUARE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8266
Practice Address - Country:US
Practice Address - Phone:208-321-1141
Practice Address - Fax:208-321-1143
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist