Provider Demographics
NPI:1205241999
Name:BLANCHARD, DAVID WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WARREN
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 1:5898 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-8714
Mailing Address - Country:US
Mailing Address - Phone:608-849-4794
Mailing Address - Fax:608-849-4790
Practice Address - Street 1:N84W15865 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3087
Practice Address - Country:US
Practice Address - Phone:262-251-6980
Practice Address - Fax:262-735-4823
Is Sole Proprietor?:No
Enumeration Date:2014-06-22
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001048-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist