Healthcare Provider Details

I. General information

NPI: 1821180852
Provider Name (Legal Business Name): T. SCOTT JENKINS, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PULASKI HWY STE V
EDGEWOOD MD
21040-1398
US

IV. Provider business mailing address

1401 PULASKI HWY STE V
EDGEWOOD MD
21040-1398
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-2523
  • Fax: 410-676-2683
Mailing address:
  • Phone: 410-679-2523
  • Fax: 410-676-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4843
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11028
License Number StateMD

VIII. Authorized Official

Name: MS. JANICE MOON
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-679-2523