Individual
MR. RAYMOND EDWARD BLANCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1802 MAIN ST, CROSS PLAINS, WI 53528-9770
(608) 798-3200
Mailing address
1802 MAIN ST, CROSS PLAINS, WI 53528-9770
(608) 798-3200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001289-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5001289015
DENTAL STATE LICENSE DEPT
WI
Enumeration date
02/21/2008
Last updated
02/21/2008
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