Spencer Sonntag Blackham, DMD, MS Valid NPI

Individual provider · Public Health Dentistry · Park City, UT

NPI

1477150316

Type

Individual (Type 1)

Primary specialty

Public Health Dentistry (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223D0001X

License number

7894995-9921 (UT)

Sex

Male

Sole proprietor

No

Enumerated

2020-10-05

Last updated

2022-06-14