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General NPI Number Information
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NPI Number | 1881039709
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Entity Type | Organization
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Legal Business Name | BLANCHARD DDS PC
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 1212 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8646
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Country | US
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Telephone | 208-375-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8646
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Country | US
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Telephone | 208-375-4253
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | TRACY TRAN
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Credential | MPH
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Telephone | 408-234-5099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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