Provider Demographics
NPI:1801565916
Name:TWIILIGHT DENTAL
Entity type:Organization
Organization Name:TWIILIGHT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-780-1109
Mailing Address - Street 1:6550 WHITTLESEY BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7339
Mailing Address - Country:US
Mailing Address - Phone:706-780-1109
Mailing Address - Fax:
Practice Address - Street 1:6550 WHITTLESEY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7339
Practice Address - Country:US
Practice Address - Phone:706-780-1109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental