Provider Demographics
NPI:1639465388
Name:JENKINS, SHELANE ALEXIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELANE
Middle Name:ALEXIS
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-278-3857
Practice Address - Street 1:2256 HEITMAN ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3744
Practice Address - Country:US
Practice Address - Phone:239-278-3600
Practice Address - Fax:239-278-3857
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist