Provider Demographics
NPI:1740290394
Name:JENKINS, CONRAD B (DDS)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:B
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:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-7546
Mailing Address - Country:US
Mailing Address - Phone:434-972-6233
Mailing Address - Fax:434-972-4310
Practice Address - Street 1:1138 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5128
Practice Address - Country:US
Practice Address - Phone:434-972-6233
Practice Address - Fax:434-972-4310
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055591223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0013970OtherDORAL DENTAL