Provider Demographics
NPI:1881215408
Name:BLANCHARD, CAITLIN (DA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 21ST ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4752
Mailing Address - Country:US
Mailing Address - Phone:941-713-1858
Mailing Address - Fax:
Practice Address - Street 1:4012 9TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1706
Practice Address - Country:US
Practice Address - Phone:941-749-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant