Provider Demographics
NPI:1114781689
Name:MAURICE G JENKINS PLLC
Entity Type:Organization
Organization Name:MAURICE G JENKINS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:GUSTAF
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:801-437-7701
Mailing Address - Street 1:280 RIVER PARK DR STE 360
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5835
Mailing Address - Country:US
Mailing Address - Phone:801-437-7701
Mailing Address - Fax:801-356-6326
Practice Address - Street 1:280 RIVER PARK DR STE 360
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5835
Practice Address - Country:US
Practice Address - Phone:801-437-7701
Practice Address - Fax:801-356-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty