Provider Demographics
NPI:1336309368
Name:TOBLER, NATHAN BLAKE (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:BLAKE
Last Name:TOBLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 N 1200 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2296
Mailing Address - Country:US
Mailing Address - Phone:801-766-3600
Mailing Address - Fax:801-766-4238
Practice Address - Street 1:181 N 1200 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2296
Practice Address - Country:US
Practice Address - Phone:801-766-3600
Practice Address - Fax:801-766-4238
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7025805-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist