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General NPI Number Information
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NPI Number | 1851553390
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Entity Type | Individual
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Provider Name | JERRY LEWIS JENKINS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1009 CROWDER DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-4237
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Country | US
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Telephone | 804-794-8745
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Fax | 804-794-3568
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Provider Business Mailing Address
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Address Line | 1009 CROWDER DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-4237
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Country | US
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Telephone | 804-794-7845
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Fax | 804-794-3568
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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 | 3746
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License Number State | VA
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