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General NPI Number Information
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NPI Number | 1730220690
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Entity Type | Individual
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Provider Name | WILLIAM BRADFORD JENKINS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 211 HIGHWAY 82 E
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City | INDIANOLA
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State | MS
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Zip | 38751-2234
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Country | US
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Telephone | 662-887-3426
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Fax | 662-887-3698
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Provider Business Mailing Address
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Address Line | 211 HIGHWAY 82 E
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City | INDIANOLA
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State | MS
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Zip | 38751-2234
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Country | US
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Telephone | 662-887-3426
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Fax | 662-887-3698
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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 | 3225
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3225
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License Number State | MS
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