David Blanco
Individual provider Active NPI Dentist · Providence, RI
NPI 1376536730 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1376536730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN02863 (RI)
- Practice address
- 557 Broad St
Providence, RI 02907-1403 - Phone
- (401) 444-0430
- Fax
- (401) 444-0489
- NPI assigned
- Aug 31, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN02863 | RI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN02863 | RI | Yes |
Addresses
Primary practice location
557 Broad St
Providence, RI 02907-1403
Mailing address
375 Allens Ave
Providence, RI 02905-5010
Phone (401) 444-0400
Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.