Provider Demographics
NPI:1396848909
Name:DENVER D JENKINS JR DDS INC
Entity Type:Organization
Organization Name:DENVER D JENKINS JR DDS INC
Other - Org Name:DR DENVER JENKINS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENVER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-221-0300
Mailing Address - Street 1:14805 DETROIT AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-221-0300
Mailing Address - Fax:216-221-0308
Practice Address - Street 1:14805 DETROIT AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-221-0300
Practice Address - Fax:216-221-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3019214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty