Healthcare Provider Details

I. General information

NPI: 1265369367
Provider Name (Legal Business Name): JENKINS AIRWAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WEST MAIN STREET
AMANDA OH
43102
US

IV. Provider business mailing address

145 WEST MAIN STREET PO BOX 296
AMANDA OH
43102
US

V. Phone/Fax

Practice location:
  • Phone: 740-969-1198
  • Fax: 740-969-1198
Mailing address:
  • Phone: 740-969-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA JENKINS
Title or Position: DENTIST
Credential: DDS
Phone: 740-969-1198