Provider Demographics
NPI:1679927750
Name:BLANKENSHIP-SNIKER, JORDAN NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:NICOLE
Last Name:BLANKENSHIP-SNIKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MARKET PL STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3943
Mailing Address - Country:US
Mailing Address - Phone:770-639-1173
Mailing Address - Fax:
Practice Address - Street 1:380 MARKET PL STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3943
Practice Address - Country:US
Practice Address - Phone:770-639-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN0152171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program