Provider Demographics
NPI:1699892448
Name:BLANCHARD, JONATHAN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:BLANCHARD
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 1:118 SOUTH 4TH STREET
Mailing Address - Street 2:BOX 190
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741
Mailing Address - Country:US
Mailing Address - Phone:406-284-3251
Mailing Address - Fax:406-284-6244
Practice Address - Street 1:118 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741
Practice Address - Country:US
Practice Address - Phone:406-284-3251
Practice Address - Fax:406-284-6244
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice