Provider Demographics
NPI:1801937768
Name:JENKINS DENTAL CARE, INC.
Entity type:Organization
Organization Name:JENKINS DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-887-3426
Mailing Address - Street 1:211 HIGHWAY 82 E
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2234
Mailing Address - Country:US
Mailing Address - Phone:662-887-3426
Mailing Address - Fax:662-887-3698
Practice Address - Street 1:211 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2234
Practice Address - Country:US
Practice Address - Phone:662-887-3426
Practice Address - Fax:662-887-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016029Medicaid