Provider Demographics
NPI:1518186063
Name:BLYTHE, KORY WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:WILLIAM
Last Name:BLYTHE
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 1:10934 E LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3096
Mailing Address - Country:US
Mailing Address - Phone:480-607-9466
Mailing Address - Fax:480-607-9413
Practice Address - Street 1:10603 N HAYDEN RD
Practice Address - Street 2:SUITE H-113
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5518
Practice Address - Country:US
Practice Address - Phone:480-607-9466
Practice Address - Fax:480-607-9413
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice