Provider Demographics
NPI:1245409465
Name:BLANCHARD, RAYMOND EDWARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1802 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9770
Mailing Address - Country:US
Mailing Address - Phone:608-798-3200
Mailing Address - Fax:
Practice Address - Street 1:1802 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-9770
Practice Address - Country:US
Practice Address - Phone:608-798-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001289-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5001289015OtherDENTAL STATE LICENSE DEPT