Healthcare Provider Details

I. General information

NPI: 1306219522
Provider Name (Legal Business Name): SHERRY R JENKINS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 BURNET RD MAIL CODE 1300
AUSTIN TX
78758-3407
US

IV. Provider business mailing address

PO BOX 85200 MAIL CODE 1300
AUSTIN TX
78708-5200
US

V. Phone/Fax

Practice location:
  • Phone: 512-491-2821
  • Fax:
Mailing address:
  • Phone: 512-491-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: