MEDICARE: SCOTT C BLANCHARD DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	6124	NC

General Provider Information

NPI Number	:	1477756211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT C BLANCHARD DDS PA

Provider Business Mailing Address
First Line	:	200 N WATER ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4484
Country	:	US
Telephone Number	:	252-335-4332
Fax Number	:	252-335-2783

Provider Business Practice Location Address
First Line	:	200 N WATER ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4484
Country	:	US
Telephone Number	:	252-335-4332
Fax Number	:	252-335-2783

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT C BLANCHARD
Credential	:	DDS
Telephone Number	:	252-335-4332

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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