Provider Demographics
NPI:1770581050
Name:BLANCHARD, JASON L
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8089 S LINCOLN ST #102
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2719
Mailing Address - Country:US
Mailing Address - Phone:303-794-9271
Mailing Address - Fax:303-794-8454
Practice Address - Street 1:8089 S LINCOLN ST #102
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2719
Practice Address - Country:US
Practice Address - Phone:303-794-9271
Practice Address - Fax:303-794-8454
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
CO8142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist