Provider Demographics
NPI:1316469653
Name:BLANCHARD, KATELYN MICHELLE (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MICHELLE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MICHELLE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-0691
Mailing Address - Country:US
Mailing Address - Phone:903-241-5136
Mailing Address - Fax:
Practice Address - Street 1:3824 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1713
Practice Address - Country:US
Practice Address - Phone:903-707-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370831223X0400X
OK2191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics