Provider Demographics
NPI:1033277934
Name:HENKIN, JEFFREY MARTIN (DDS, MS, FICD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARTIN
Last Name:HENKIN
Suffix:
Gender:M
Credentials:DDS, MS, FICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24860 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-4610
Mailing Address - Fax:909-558-4801
Practice Address - Street 1:24860 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4610
Practice Address - Fax:909-558-4801
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A140701223P0300X
CA566701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics