Provider Demographics
NPI:1548319478
Name:JENKINS, VALERIE TONNU (DMD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:TONNU
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 CHURCH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6894
Mailing Address - Country:US
Mailing Address - Phone:909-989-2300
Mailing Address - Fax:909-989-2588
Practice Address - Street 1:10601 CHURCH ST STE 104
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6894
Practice Address - Country:US
Practice Address - Phone:909-989-2300
Practice Address - Fax:909-989-2588
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93930-01Medicaid