Provider Demographics
NPI:1417199621
Name:DENTURE & IMPLANT CENTER
Entity Type:Organization
Organization Name:DENTURE & IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-474-9877
Mailing Address - Street 1:1631 NEVADA HWY
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-1908
Mailing Address - Country:US
Mailing Address - Phone:702-474-9877
Mailing Address - Fax:702-293-2335
Practice Address - Street 1:1631 NEVADA HWY
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1908
Practice Address - Country:US
Practice Address - Phone:702-474-9877
Practice Address - Fax:702-293-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV04611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty