Provider Demographics
NPI:1548506785
Name:BLANCHARD DENTISTRY, PLLC
Entity type:Organization
Organization Name:BLANCHARD DENTISTRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-321-1300
Mailing Address - Street 1:506 PINEWOOD SQ
Mailing Address - Street 2:(32ND STREET & HOLLY ROAD)
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3925
Mailing Address - Country:US
Mailing Address - Phone:757-321-1300
Mailing Address - Fax:757-321-0778
Practice Address - Street 1:506 PINEWOOD SQ
Practice Address - Street 2:(32ND STREET & HOLLY ROAD)
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3925
Practice Address - Country:US
Practice Address - Phone:757-321-1300
Practice Address - Fax:757-321-0778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty