Provider Demographics
NPI:1336111319
Name:JENKINS, STEPHEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:10151 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE - 2B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3670
Mailing Address - Country:US
Mailing Address - Phone:505-830-3636
Mailing Address - Fax:505-830-2305
Practice Address - Street 1:10151 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE - 2B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3670
Practice Address - Country:US
Practice Address - Phone:505-830-3636
Practice Address - Fax:505-830-2305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMDD21731223E0200X
MO20010126031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics