Provider Demographics
NPI:1902901416
Name:BLANCHARD, MILTON CLARK (DDS)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:CLARK
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1982
Mailing Address - Country:US
Mailing Address - Phone:425-641-8600
Mailing Address - Fax:425-641-7730
Practice Address - Street 1:4301 FACTORIA BLVD SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1982
Practice Address - Country:US
Practice Address - Phone:425-641-8600
Practice Address - Fax:425-641-7730
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice