Blake Imam, DMD

NPI #1285040394 in Meridian, Idaho

Provider Information

NPI Number: 1285040394
Entity Type: Individual
Name: Blake Imam, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DMD
Enumeration Date: Jul 9, 2014
Last Updated: Jul 9, 2014

Practice Location

Address: 317 W CHERRY LN
City: Meridian
State: Idaho
ZIP Code: 83642-1608
Phone: (208) 888-2055

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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