Provider Demographics
NPI:1356073621
Name:BLODGETT, COLE MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:MATTHEW
Last Name:BLODGETT
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 1:2800 4TH ST SW STE 1
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1596
Mailing Address - Country:US
Mailing Address - Phone:262-825-7234
Mailing Address - Fax:
Practice Address - Street 1:2800 4TH ST SW STE 1
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1596
Practice Address - Country:US
Practice Address - Phone:641-424-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-100101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice