Provider Demographics
NPI:1376508804
Name:JENKINS, DEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:
Last Name:JENKINS
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 1:1094 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6138
Mailing Address - Country:US
Mailing Address - Phone:541-779-4344
Mailing Address - Fax:541-776-9849
Practice Address - Street 1:1094 ROYAL CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6138
Practice Address - Country:US
Practice Address - Phone:541-779-4344
Practice Address - Fax:541-776-9849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice