Provider Demographics
NPI:1093374456
Name:BLATCHLEY DENTAL CORPORATION
Entity Type:Organization
Organization Name:BLATCHLEY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:BLATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-508-4935
Mailing Address - Street 1:426 BARCELLUS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6926
Mailing Address - Country:US
Mailing Address - Phone:805-347-4785
Mailing Address - Fax:805-347-4787
Practice Address - Street 1:426 BARCELLUS AVE STE 105
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6926
Practice Address - Country:US
Practice Address - Phone:805-347-4785
Practice Address - Fax:805-347-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty