Provider Demographics
NPI:1831194414
Name:JENKINS, JANIS SUE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:SUE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 PINTAIL WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9668
Mailing Address - Country:US
Mailing Address - Phone:720-684-6310
Mailing Address - Fax:
Practice Address - Street 1:5858 PINTAIL WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-9668
Practice Address - Country:US
Practice Address - Phone:720-684-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140711223G0001X
CO101101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice