Provider Demographics
NPI:1225078819
Name:JENKINS, DAVID BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
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 1:161 THUNDER DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6052
Mailing Address - Country:US
Mailing Address - Phone:760-758-8506
Mailing Address - Fax:760-758-5775
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:SUITE 208
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6052
Practice Address - Country:US
Practice Address - Phone:760-758-8506
Practice Address - Fax:760-758-5775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice