Provider Demographics
NPI:1598146680
Name:BLACHER, JONATHAN DAVID (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:BLACHER
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 FM 423 STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4745
Mailing Address - Country:US
Mailing Address - Phone:214-609-1415
Mailing Address - Fax:214-609-1423
Practice Address - Street 1:1901 FM 423 STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4745
Practice Address - Country:US
Practice Address - Phone:214-609-1415
Practice Address - Fax:214-609-1423
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328641223E0200X
CT114141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty