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General NPI Number Information
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NPI Number | 1114781689
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Entity Type | Organization
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Legal Business Name | MAURICE G JENKINS PLLC
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 280 RIVER PARK DR STE 360
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City | PROVO
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State | UT
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Zip | 84604-5835
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Country | US
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Telephone | 801-437-7701
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Fax | 801-356-6326
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Provider Business Mailing Address
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Address Line | 280 RIVER PARK DR STE 360
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City | PROVO
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State | UT
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Zip | 84604-5835
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Country | US
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Telephone | 801-437-7701
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Fax | 801-356-6326
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAURICE GUSTAF JENKINS
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Credential | D.D.S., M.D.
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Telephone | 801-437-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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