Provider Demographics
NPI:1275867079
Name:BLUFFTON DENTAL CARE PC
Entity Type:Organization
Organization Name:BLUFFTON DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:8437-063-8000
Mailing Address - Street 1:25 CLARK SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4205
Mailing Address - Country:US
Mailing Address - Phone:843-706-3800
Mailing Address - Fax:843-406-3802
Practice Address - Street 1:25 CLARK SUMMIT DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4205
Practice Address - Country:US
Practice Address - Phone:843-706-3800
Practice Address - Fax:843-406-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty