Provider Demographics
NPI:1740514413
Name:JENKINS, MARTIN WANG (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WANG
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 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-332-2680
Practice Address - Street 1:8359 STRINGFELLOW RD
Practice Address - Street 2:
Practice Address - City:ST JAMES CITY
Practice Address - State:FL
Practice Address - Zip Code:33956-2910
Practice Address - Country:US
Practice Address - Phone:239-344-2393
Practice Address - Fax:239-283-9276
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18874122300000X
VA0401412645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist