Provider Demographics
NPI:1912322108
Name:OBLAD, STEPHEN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:OBLAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E 3900 S STE 212
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4413
Mailing Address - Country:US
Mailing Address - Phone:801-278-2826
Mailing Address - Fax:801-278-7365
Practice Address - Street 1:1345 E 3900 S STE 212
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4413
Practice Address - Country:US
Practice Address - Phone:801-278-2826
Practice Address - Fax:801-278-7265
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9037653-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist