Provider Demographics
NPI:1235545674
Name:JENKINS, BRITANY RAE
Entity Type:Individual
Prefix:
First Name:BRITANY
Middle Name:RAE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CLUBVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1703
Mailing Address - Country:US
Mailing Address - Phone:214-454-1051
Mailing Address - Fax:
Practice Address - Street 1:1565 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3394
Practice Address - Country:US
Practice Address - Phone:972-436-0788
Practice Address - Fax:972-436-9188
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist