Provider Demographics
NPI:1114053915
Name:JENKINS, RANDALL DEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DEE
Last Name:JENKINS
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 1:544 ULUHAKU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4411
Mailing Address - Country:US
Mailing Address - Phone:808-261-0949
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE C309
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1801
Practice Address - Country:US
Practice Address - Phone:808-254-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist