Provider Demographics
NPI:1942560867
Name:JENKINS, TERA LEATRICE (RDH)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:LEATRICE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:TERA
Other - Middle Name:LEATRICE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:82 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2131
Mailing Address - Country:US
Mailing Address - Phone:585-423-5800
Mailing Address - Fax:
Practice Address - Street 1:82 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2131
Practice Address - Country:US
Practice Address - Phone:585-423-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDH020554124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist