Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 006543 | CT |
NPI | 1063604924 |
---|---|
Provider Name | Susan Blanchard |
First Address | Middletown, CT 06457-2718 |
Second Address | Stamford, CT 06901-1014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 15/08/2007 |