Healthcare Provider Details

I. General information

NPI: 1033952106
Provider Name (Legal Business Name): BLANCHARD MOLAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 N COUNCIL AVE
BLANCHARD OK
73010-8037
US

IV. Provider business mailing address

1119 N COUNCIL AVE
BLANCHARD OK
73010-8037
US

V. Phone/Fax

Practice location:
  • Phone: 405-485-2020
  • Fax: 405-485-8779
Mailing address:
  • Phone: 405-485-2020
  • Fax: 405-485-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRK MURRAY
Title or Position: OWNER
Credential: DMD
Phone: 405-328-1240