Provider Demographics
NPI:1144386970
Name:RALPH V. BLANCHARD, JR DDS PC
Entity Type:Organization
Organization Name:RALPH V. BLANCHARD, JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-663-5153
Mailing Address - Street 1:176 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-4513
Mailing Address - Country:US
Mailing Address - Phone:413-663-5153
Mailing Address - Fax:413-663-3459
Practice Address - Street 1:176 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4513
Practice Address - Country:US
Practice Address - Phone:413-663-5153
Practice Address - Fax:413-663-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0249629Medicaid
MAX05494OtherBCBS PROVIDER NUMBER