Healthcare Provider Details

I. General information

NPI: 1760314918
Provider Name (Legal Business Name): DARA MARY BLANCHETTE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARA MARY COOPER RDH

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 6TH AVE
TROY NY
12180-4584
US

IV. Provider business mailing address

1520 6TH AVE
TROY NY
12180-4584
US

V. Phone/Fax

Practice location:
  • Phone: 518-274-2660
  • Fax: 518-272-0683
Mailing address:
  • Phone: 518-274-2660
  • Fax: 518-272-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number032892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: