Provider Demographics
NPI:1407010010
Name:BLANCHARD, SAMUEL GREGG (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GREGG
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:39400 GARFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4096
Mailing Address - Country:US
Mailing Address - Phone:586-286-0700
Mailing Address - Fax:
Practice Address - Street 1:39400 GARFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4096
Practice Address - Country:US
Practice Address - Phone:586-286-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019904122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist