Provider Demographics
NPI:1497912356
Name:REMY H BLANCHAERT JR DDS MD PA
Entity Type:Organization
Organization Name:REMY H BLANCHAERT JR DDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLANCHAERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:316-634-1414
Mailing Address - Street 1:1919 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3405
Mailing Address - Country:US
Mailing Address - Phone:316-634-1414
Mailing Address - Fax:316-634-2907
Practice Address - Street 1:1919 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3405
Practice Address - Country:US
Practice Address - Phone:316-634-1414
Practice Address - Fax:316-634-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-311761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420750CMedicaid
KS107125OtherBCBS
KSU61931Medicare UPIN
KS100420750CMedicaid