Provider Demographics
NPI:1881738557
Name:BLANKENSHIP, JEFFREY C (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LILBURN STONE MOUNTAIN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1857
Mailing Address - Country:US
Mailing Address - Phone:770-879-0732
Mailing Address - Fax:770-879-0869
Practice Address - Street 1:1505 LILBURN STONE MOUNTAIN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1857
Practice Address - Country:US
Practice Address - Phone:770-879-0732
Practice Address - Fax:770-879-0869
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 100021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice