Healthcare Provider Details

I. General information

NPI: 1073443545
Provider Name (Legal Business Name): BRANDON JENKINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4622 COUNTRY CLUB RD
WINSTON SALEM NC
27104-3769
US

IV. Provider business mailing address

2566 NC HIGHWAY 801 S
ADVANCE NC
27006-7102
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-3357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14673
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: