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NPI Code Detail

MEDICARE: DR. M DOUGLAS JENKINS DDS

MEDICARE:  DR. M DOUGLAS JENKINS  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist135199UT

General Provider Information

NPI Number : 1841474160
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. M DOUGLAS JENKINS DDS
Provider Business Mailing Address
First Line : 4970 S 900 E
Second Line : SUITE G
City : SALT LAKE CITY
State : UT
Zip : 84117-5776
Country : US
Telephone Number : 801-262-6811
Fax Number :
Provider Business Practice Location Address
First Line : 4970 S 900 E
Second Line : SUITE G
City : SALT LAKE CITY
State : UT
Zip : 84117-5776
Country : US
Telephone Number : 801-262-6811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2007
Last Update Date : 12/21/2007

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Directions to “ DR. M DOUGLAS JENKINS DDS” Practice Location

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