MEDICARE: BLANCHARD INC

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	122300000X	Dentist	0461	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0461	OTHER	NV	DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1952604027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLANCHARD INC

Provider Business Mailing Address
First Line	:	2605 S DECATUR BLVD
Second Line	:	116
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8591
Country	:	US
Telephone Number	:	702-876-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 S DECATUR BLVD
Second Line	:	116
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8591
Country	:	US
Telephone Number	:	702-876-2525
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD BLANCHARD
Credential	:	DDS
Telephone Number	:	702-876-2525

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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Directions to “BLANCHARD INC ” Practice Location

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