Provider Demographics
NPI:1689773343
Name:DESIGNING SMILES PSC
Entity Type:Organization
Organization Name:DESIGNING SMILES PSC
Other - Org Name:DENNIS J JENKINS DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-246-3386
Mailing Address - Street 1:7709 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172
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
Practice Address - Country:US
Practice Address - Phone:812-246-3386
Practice Address - Fax:812-246-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12009023OtherDENTIST LICENSE