Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 05 057262 | NY |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 057262 | NY |
NPI | 1124434659 |
---|---|
Provider Name | Dr. Ariel Blanchard |
First Address | New York, NY 10024-5110 |
Second Address | New York, NY 10065-6007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 03/05/2020 |