Provider Demographics
NPI:1477664118
Name:JENKINS, JAMES G
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLARK SUMMIT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4999
Mailing Address - Country:US
Mailing Address - Phone:843-706-3800
Mailing Address - Fax:843-706-3802
Practice Address - Street 1:25 CLARK SUMMIT DR STE 100
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4999
Practice Address - Country:US
Practice Address - Phone:843-706-3800
Practice Address - Fax:843-706-3802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010143122300000X
SC4414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist