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General NPI Number Information
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NPI Number | 1134921646
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Entity Type | Organization
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Legal Business Name | JENKS DENTAL CO., PLLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 725 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3518
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Country | US
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Telephone | 918-528-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 400 RIVERWALK TER STE 250
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City | JENKS
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State | OK
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Zip | 74037-5619
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Country | US
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Telephone | 918-998-0996
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Fax | 918-235-9079
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | CREED CARDON
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Credential | DDS
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Telephone | 918-998-0996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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