Provider Demographics
NPI:1447392402
Name:BLANCHARD, ANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 COVE LN
Mailing Address - Street 2:# E
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3576
Mailing Address - Country:US
Mailing Address - Phone:773-931-3915
Mailing Address - Fax:847-297-3223
Practice Address - Street 1:333 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2703
Practice Address - Country:US
Practice Address - Phone:312-738-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice