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General NPI Number Information
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NPI Number | 1295873727
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Entity Type | Individual
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Provider Name | BRAD R JENKINS DDS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 1115 S MAIN ST
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City | FORT SCOTT
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State | KS
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Zip | 66701-2651
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Country | US
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Telephone | 620-223-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 13849 MEADOW CIR
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City | LEAWOOD
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State | KS
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Zip | 66224-4565
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Country | US
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Telephone | 913-685-3323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | KS 7195
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License Number State | KS
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