Provider Demographics
NPI:1275547952
Name:JENKINS, ALVIN PHILLIPS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:PHILLIPS
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 1:420 E. SECOND ST.
Mailing Address - Street 2:P. O. BOX 387
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-0387
Mailing Address - Country:US
Mailing Address - Phone:336-246-8888
Mailing Address - Fax:336-846-3138
Practice Address - Street 1:420 E. SECOND ST.
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-0387
Practice Address - Country:US
Practice Address - Phone:336-246-8888
Practice Address - Fax:336-846-3138
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC94553OtherBCBSNC
NC2339397Medicaid
NC2339397Medicaid
NC94553OtherBCBSNC