Healthcare Provider Details

I. General information

NPI: 1083698260
Provider Name (Legal Business Name): STEVEN T BLANCHARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SKYLINE DR
BRIGHAM CITY UT
84302-3108
US

IV. Provider business mailing address

105 SKYLINE DR
BRIGHAM CITY UT
84302-3108
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-9200
  • Fax: 435-723-6371
Mailing address:
  • Phone: 435-723-9200
  • Fax: 435-723-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7454741
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7454741
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: