Provider Demographics
NPI:1659682912
Name:JENKINS, JOSHUA ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ALAN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1411 FALLS AVE E
Mailing Address - Street 2:#1000C
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-734-7415
Mailing Address - Fax:208-733-1922
Practice Address - Street 1:1411 FALLS AVE E
Practice Address - Street 2:#1000C
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3455
Practice Address - Country:US
Practice Address - Phone:208-734-7415
Practice Address - Fax:208-734-7415
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDD-4569-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry