Provider Demographics
NPI:1891890463
Name:JENKINS, DAMON (DMD)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BUCKLAND STREET
Mailing Address - Street 2:UNIT 1033-4
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:504-400-0682
Mailing Address - Fax:860-533-9027
Practice Address - Street 1:483 WEST MIDDLE TURNPIKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-645-0111
Practice Address - Fax:860-533-9027
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics