Healthcare Provider Details

I. General information

NPI: 1275547952
Provider Name (Legal Business Name): ALVIN PHILLIPS JENKINS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E. SECOND ST.
WEST JEFFERSON NC
28694-0387
US

IV. Provider business mailing address

420 E. SECOND ST. P. O. BOX 387
WEST JEFFERSON NC
28694-0387
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-8888
  • Fax: 336-846-3138
Mailing address:
  • Phone: 336-246-8888
  • Fax: 336-846-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4208
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: