Provider Demographics
NPI:1285831990
Name:JENKINS, MAURICE GUSTAF (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:GUSTAF
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:280 RIVER PARK DR STE 360
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5835
Mailing Address - Country:US
Mailing Address - Phone:801-437-7701
Mailing Address - Fax:801-356-6326
Practice Address - Street 1:280 RIVER PARK DR STE 360
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5835
Practice Address - Country:US
Practice Address - Phone:801-437-7701
Practice Address - Fax:801-356-6326
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE67001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery