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NPI Code Detail

MEDICARE: DR. GRETCHEN GREEN BLANCHARD DMD

MEDICARE:  DR. GRETCHEN GREEN BLANCHARD  DMD
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
1122300000XDentistDN013578GA

General Provider Information

NPI Number : 1508061805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRETCHEN GREEN BLANCHARD DMD
Provider Business Mailing Address
First Line : 3702 WASHINGTON RD
Second Line :
City : MARTINEZ
State : GA
Zip : 30907-2848
Country : US
Telephone Number : 706-863-5337
Fax Number : 706-855-8249
Provider Business Practice Location Address
First Line : 3702 WASHINGTON RD
Second Line :
City : MARTINEZ
State : GA
Zip : 30907-2848
Country : US
Telephone Number : 706-863-5337
Fax Number : 706-855-8249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 07/08/2007

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Directions to “ DR. GRETCHEN GREEN BLANCHARD DMD” Practice Location

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