Provider Demographics
NPI:1609935220
Name:JENKINS, NICOLE FALLAHZADEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:FALLAHZADEH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 BRENNEN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6281
Mailing Address - Country:US
Mailing Address - Phone:859-913-4472
Mailing Address - Fax:
Practice Address - Street 1:4384 CLEARWATER WAY
Practice Address - Street 2:STE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6337
Practice Address - Country:US
Practice Address - Phone:859-913-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist