Provider Demographics
NPI:1407243579
Name:MICHAEL A BLAMIRES DDS, INC
Entity Type:Organization
Organization Name:MICHAEL A BLAMIRES DDS, INC
Other - Org Name:CANYON RIDGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BLAMIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-710-3536
Mailing Address - Street 1:1770 COMBE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5067
Mailing Address - Country:US
Mailing Address - Phone:801-621-8440
Mailing Address - Fax:801-627-9063
Practice Address - Street 1:1770 COMBE RD STE 3
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5067
Practice Address - Country:US
Practice Address - Phone:801-621-8440
Practice Address - Fax:801-627-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361602-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental