MEDICARE: DR. STEVEN BENEDICT BLANCHARD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	1210481A	IN

General Provider Information

NPI Number	:	1760496954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN BENEDICT BLANCHARD DDS

Provider Business Mailing Address
First Line	:	1121 W MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5211
Country	:	US
Telephone Number	:	317-274-5129
Fax Number	:	317-274-1363

Provider Business Practice Location Address
First Line	:	1121 W MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5211
Country	:	US
Telephone Number	:	317-274-5129
Fax Number	:	317-274-1363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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