Provider Demographics
NPI:1629122957
Name:JENKINS, JEFF C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:C
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 1:5109 BRENTWOOD STAIR RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2809
Mailing Address - Country:US
Mailing Address - Phone:817-457-4078
Mailing Address - Fax:817-446-5888
Practice Address - Street 1:5109 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2809
Practice Address - Country:US
Practice Address - Phone:817-457-4078
Practice Address - Fax:817-446-5888
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice