Provider Demographics
NPI:1952319634
Name:JEFFREY A. BLANKENBECKLER, DDS, LTD
Entity Type:Organization
Organization Name:JEFFREY A. BLANKENBECKLER, DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-895-7200
Mailing Address - Street 1:611 PARK MEADOW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2875
Mailing Address - Country:US
Mailing Address - Phone:614-895-7200
Mailing Address - Fax:614-895-3663
Practice Address - Street 1:611 PARK MEADOW RD
Practice Address - Street 2:SUITE D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2875
Practice Address - Country:US
Practice Address - Phone:614-895-7200
Practice Address - Fax:614-895-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184831223G0001X
OH30-0221521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty