Provider Demographics
NPI:1134294333
Name:JENKINS, THEODORE JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOHN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-284-8089
Mailing Address - Fax:716-284-8083
Practice Address - Street 1:515 THIRD ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-284-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316931223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics