Provider Demographics
NPI:1003835828
Name:JENKINS, CARL SEES (DDS MS FAGD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:SEES
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DDS MS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-1618
Mailing Address - Country:US
Mailing Address - Phone:570-538-5005
Mailing Address - Fax:570-538-1808
Practice Address - Street 1:315 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-1618
Practice Address - Country:US
Practice Address - Phone:570-538-5005
Practice Address - Fax:570-538-1808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027565-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice