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General NPI Number Information
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NPI Number | 1962666032
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Entity Type | Organization
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Legal Business Name | BLANCHARD, SWINSON, FOGLE
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 98 N PARK DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1645
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Country | US
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Telephone | 770-461-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 98 N PARK DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1645
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Country | US
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Telephone | 770-461-1141
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DENISE HOOD
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Credential |
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Telephone | 770-631-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | AB6670283
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License Number State | GA
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