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General NPI Number Information
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NPI Number | 1407385669
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Entity Type | Individual
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Provider Name | DAVID JENKINS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 2714 HIGHWAY 155
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2401
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Country | US
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Telephone | 470-502-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 HIGHWAY 155
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2401
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Country | US
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Telephone | 470-502-0820
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN015433
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License Number State | GA
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