Provider Demographics
NPI:1255395513
Name:BLADEN, BOYD KENT (DDS)
Entity type:Individual
Prefix:
First Name:BOYD
Middle Name:KENT
Last Name:BLADEN
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 1:1662 WEST 9000 SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-255-6581
Mailing Address - Fax:801-562-5395
Practice Address - Street 1:1662 WEST 9000 SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-255-6581
Practice Address - Fax:801-562-5395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist