Provider Demographics
NPI:1063870319
Name:BLATCHLEY, RYAN TAYLOR (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:TAYLOR
Last Name:BLATCHLEY
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 1:426 BARCELLUS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6926
Mailing Address - Country:US
Mailing Address - Phone:805-347-4785
Mailing Address - Fax:805-347-4787
Practice Address - Street 1:426 BARCELLUS AVE STE 105
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6926
Practice Address - Country:US
Practice Address - Phone:805-347-4785
Practice Address - Fax:805-347-4787
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist