Healthcare Provider Details

I. General information

NPI: 1235239138
Provider Name (Legal Business Name): PAUL MORTON JENKS DOM, LPAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4532
US

IV. Provider business mailing address

4010 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87107-4532
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-2964
  • Fax: 505-884-4958
Mailing address:
  • Phone: 505-872-2964
  • Fax: 505-884-4958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1355
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number760
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: