Provider Demographics
NPI:1679700124
Name:JENKINS, DENNIS JEROME (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JEROME
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 1:7709 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1819
Mailing Address - Country:US
Mailing Address - Phone:812-246-3386
Mailing Address - Fax:812-246-1292
Practice Address - Street 1:7709 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1819
Practice Address - Country:US
Practice Address - Phone:812-246-3386
Practice Address - Fax:812-246-1292
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice