Provider Demographics
NPI:1205948619
Name:BLANCHARD, GLEN DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:DAVID
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 1:4364 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4602
Mailing Address - Country:US
Mailing Address - Phone:972-394-1492
Mailing Address - Fax:972-394-8650
Practice Address - Street 1:4364 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4602
Practice Address - Country:US
Practice Address - Phone:972-394-1492
Practice Address - Fax:972-394-8650
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice