Provider Demographics
NPI:1407933591
Name:JENKINS, BRUCE AUBREY (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:AUBREY
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 1:952 LUPIN AVE
Mailing Address - Street 2:#100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0933
Mailing Address - Country:US
Mailing Address - Phone:530-342-4300
Mailing Address - Fax:530-342-4360
Practice Address - Street 1:952 LUPIN AVE
Practice Address - Street 2:#100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0933
Practice Address - Country:US
Practice Address - Phone:530-342-4300
Practice Address - Fax:530-342-4360
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice