Provider Demographics
NPI:1407953862
Name:M. CLARK BLANCHARD DDS PLLC
Entity Type:Organization
Organization Name:M. CLARK BLANCHARD DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-641-8600
Mailing Address - Street 1:4301 FACTORIA BLVD SE
Mailing Address - Street 2:
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:SUITE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty