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NPI Code Detail

MEDICARE: DR. JEFFREY C BLANKENSHIP DMD

MEDICARE: DR. JEFFREY C BLANKENSHIP DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryGA 10002GA

General Provider Information

NPI Number : 1881738557
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY C BLANKENSHIP DMD
Provider Business Mailing Address
First Line : 1505 LILBURN STONE MOUNTAIN RD
Second Line : SUITE 130
City : STONE MOUNTAIN
State : GA
Zip : 30087-1857
Country : US
Telephone Number : 770-879-0732
Fax Number : 770-879-0869
Provider Business Practice Location Address
First Line : 1505 LILBURN STONE MOUNTAIN RD
Second Line : SUITE 130
City : STONE MOUNTAIN
State : GA
Zip : 30087-1857
Country : US
Telephone Number : 770-879-0732
Fax Number : 770-879-0869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 07/08/2007

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