Healthcare Provider Details

I. General information

NPI: 1649107657
Provider Name (Legal Business Name): JENKINS FAMILY DENTAL
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 PO BOX 296
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:
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