Provider Demographics
NPI:1407068786
Name:JEFF C JENKINS DDS PC
Entity Type:Organization
Organization Name:JEFF C JENKINS DDS PC
Other - Org Name:WOODHAVEN GENERAL AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-457-4078
Mailing Address - Street 1:5109 BRENTWOOD STAIR RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2809
Mailing Address - Country:US
Mailing Address - Phone:817-457-4078
Mailing Address - Fax:817-446-5888
Practice Address - Street 1:5109 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2809
Practice Address - Country:US
Practice Address - Phone:817-457-4078
Practice Address - Fax:817-446-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty