Healthcare Provider Details

I. General information

NPI: 1376508804
Provider Name (Legal Business Name): DEVIN JENKINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 S CRISMON RD # 103
MESA AZ
85208-2661
US

IV. Provider business mailing address

3228 E FOUNTAIN ST
MESA AZ
85213-5527
US

V. Phone/Fax

Practice location:
  • Phone: 520-220-5266
  • Fax:
Mailing address:
  • Phone: 503-746-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: