Provider Demographics
NPI:1508061805
Name:BLANCHARD, GRETCHEN GREEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:GREEN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2848
Mailing Address - Country:US
Mailing Address - Phone:706-863-5337
Mailing Address - Fax:706-855-8249
Practice Address - Street 1:3702 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2848
Practice Address - Country:US
Practice Address - Phone:706-863-5337
Practice Address - Fax:706-855-8249
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist