Provider Demographics
NPI:1326038852
Name:LARKINS, KENYA JIHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENYA
Middle Name:JIHAD
Last Name:LARKINS
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 1:11092 HIGHWAY 51 S STE B
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-4947
Mailing Address - Country:US
Mailing Address - Phone:901-412-9540
Mailing Address - Fax:
Practice Address - Street 1:11092 HIGHWAY 51 S STE B
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-4947
Practice Address - Country:US
Practice Address - Phone:901-412-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS82201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440255Medicaid