Provider Demographics
NPI:1609917921
Name:BLANCHARD, SCOTT C (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4484
Mailing Address - Country:US
Mailing Address - Phone:252-335-4332
Mailing Address - Fax:252-335-2783
Practice Address - Street 1:200 N WATER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4484
Practice Address - Country:US
Practice Address - Phone:252-335-4332
Practice Address - Fax:252-335-2783
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics