Healthcare Provider Details

I. General information

NPI: 1861320384
Provider Name (Legal Business Name): WEST CLINTON FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W CLINTON ST STE 5
GRAY GA
31032-5463
US

IV. Provider business mailing address

250 W CLINTON ST STE 5
GRAY GA
31032-5463
US

V. Phone/Fax

Practice location:
  • Phone: 478-986-1830
  • Fax:
Mailing address:
  • Phone: 478-986-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB A. JENKINS
Title or Position: GENERAL DENTIST/OWNER
Credential: DMD
Phone: 206-458-8422