Provider Demographics
NPI:1598992257
Name:JENKINS-TUTTLE, KARA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:MICHELLE
Last Name:JENKINS-TUTTLE
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 1:200 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1737
Mailing Address - Country:US
Mailing Address - Phone:304-842-3577
Mailing Address - Fax:
Practice Address - Street 1:200 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1737
Practice Address - Country:US
Practice Address - Phone:304-842-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145151223G0001X
WV38731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice