Provider Demographics
NPI:1629169453
Name:BLANCHARD, ROBERT PAUL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:BLANCHARD
Suffix:JR
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 1:1222 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2102
Mailing Address - Country:US
Mailing Address - Phone:281-488-8973
Mailing Address - Fax:281-488-8992
Practice Address - Street 1:1222 CLEAR LAKE CITY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2102
Practice Address - Country:US
Practice Address - Phone:281-488-8973
Practice Address - Fax:281-488-8992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760134281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice