Healthcare Provider Details

I. General information

NPI: 1699892448
Provider Name (Legal Business Name): JONATHAN WILLIAM BLANCHARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S 4TH ST
MANHATTAN MT
59741
US

IV. Provider business mailing address

118 SOUTH 4TH STREET BOX 190
MANHATTAN MT
59741
US

V. Phone/Fax

Practice location:
  • Phone: 406-284-3251
  • Fax: 406-284-6244
Mailing address:
  • Phone: 406-284-3251
  • Fax: 406-284-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2203
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: