Provider Demographics
NPI:1306219522
Name:JENKINS, SHERRY R (RDH)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85200
Mailing Address - Street 2:MAIL CODE 1300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-5200
Mailing Address - Country:US
Mailing Address - Phone:512-491-2821
Mailing Address - Fax:
Practice Address - Street 1:11501 BURNET RD
Practice Address - Street 2:MAIL CODE 1300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3407
Practice Address - Country:US
Practice Address - Phone:512-491-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5392124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist