Provider Demographics
NPI:1952318024
Name:TOMLINSON, BLAIR D (DDS)
Entity Type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:D
Last Name:TOMLINSON
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 1:360 S FORT LN STE 108
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4202
Mailing Address - Country:US
Mailing Address - Phone:801-546-1066
Mailing Address - Fax:
Practice Address - Street 1:360 S FORT LN
Practice Address - Street 2:#108
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4259
Practice Address - Country:US
Practice Address - Phone:801-546-1066
Practice Address - Fax:801-546-1967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1452961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice