Provider Demographics
NPI:1528220860
Name:JENKINS, ROBERT THEODORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THEODORE
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 1:515 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1507
Mailing Address - Country:US
Mailing Address - Phone:716-284-0088
Mailing Address - Fax:716-284-0088
Practice Address - Street 1:515 3RD ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1507
Practice Address - Country:US
Practice Address - Phone:716-284-0088
Practice Address - Fax:716-284-0088
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053859-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY053859-1OtherSTATE OF NEW YORK