Provider Demographics
NPI:1508997131
Name:JENKINS, TANEK LATRICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANEK
Middle Name:LATRICE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041 EDGEWATER TER
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5766
Mailing Address - Country:US
Mailing Address - Phone:301-749-8510
Mailing Address - Fax:
Practice Address - Street 1:6710 OXON HILL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1121
Practice Address - Country:US
Practice Address - Phone:301-686-0710
Practice Address - Fax:301-686-0740
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry