Provider Demographics
NPI:1386720688
Name:BLANCHARD, CAROL A (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STEARNS AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-1133
Mailing Address - Country:US
Mailing Address - Phone:617-241-9220
Mailing Address - Fax:
Practice Address - Street 1:16 SEVER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1305
Practice Address - Country:US
Practice Address - Phone:617-241-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist